Abstract
Background: No recipient risk index exists predicting short-term mortality after orthotopic heart transplantation (OHT). We utilized United Network for Organ Sharing (UNOS) data to develop a novel quantitative recipient risk score for use in OHT. Methods: A prospectively collected open cohort of 21,378 primary OHT patients (1997 to 2008) was randomly divided into subgroups. The training cohort (n = 17,079) was used for score derivation and the test cohort (n = 4,299) was used for independent validation. Recipient specific variables associated with 1-year mortality (exploratory p value <0.2) were incorporated stepwise into a multivariable logistic regression model. The final model contained variables which maximized explanatory power (assessed by pseudo R2, area under the curve, and likelihood-ratio test). A risk index was created by apportioning points approximating the relative impact of variables on 1-year mortality. The Kaplan-Meier method was used to assess impact of risk score on short-term survival. Results: The 50-point scoring system incorporated 12 recipient specific variables. Derivation and validation cohort scores ranged from 0 to 33 and 0 to 27, respectively (mean 6.1 ± 3.7 and 6.1 ± 3.7). Each point increased the odds of 1-year death by 14% in the derivation cohort (odds ratio 1.14 [1.13 to 1.15], p <0.001) and 15% in the validation cohort (odds ratio 1.15 [1.12 to 1.17], p <0001). One-year survivals in the validation cohort (by increments of 3 points) were the following: 0 to 2 (92.5%); 3 to 5 (89.9%); 7 to 9 (86.3%); and 10 or greater (74.9%); p <0.001. Patients transplanted with risk scores of 20 or higher had 1-year mortality rates greater than 50%. Conclusions: We present a novel internally validated OHT recipient risk score, which is highly predictive of 1-year mortality. This risk index may prove valuable for patient prognosis, organ allocation, and research stratification in OHT.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 914-922 |
| Number of pages | 9 |
| Journal | Annals of Thoracic Surgery |
| Volume | 92 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 2011 |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Surgery
- Pulmonary and Respiratory Medicine
Cite this
Creation of a quantitative recipient risk index for mortality prediction after cardiac transplantation (IMPACT). / Weiss, Eric S.; Allen, Jeremiah G.; Arnaoutakis, George J.; George, Timothy J.; Russell, Stuart D.; Shah, Ashish S.; Conte, John V.
In: Annals of Thoracic Surgery, Vol. 92, No. 3, 09.2011, p. 914-922.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Creation of a quantitative recipient risk index for mortality prediction after cardiac transplantation (IMPACT)
AU - Weiss, Eric S.
AU - Allen, Jeremiah G.
AU - Arnaoutakis, George J.
AU - George, Timothy J.
AU - Russell, Stuart D.
AU - Shah, Ashish S.
AU - Conte, John V.
PY - 2011/9
Y1 - 2011/9
N2 - Background: No recipient risk index exists predicting short-term mortality after orthotopic heart transplantation (OHT). We utilized United Network for Organ Sharing (UNOS) data to develop a novel quantitative recipient risk score for use in OHT. Methods: A prospectively collected open cohort of 21,378 primary OHT patients (1997 to 2008) was randomly divided into subgroups. The training cohort (n = 17,079) was used for score derivation and the test cohort (n = 4,299) was used for independent validation. Recipient specific variables associated with 1-year mortality (exploratory p value <0.2) were incorporated stepwise into a multivariable logistic regression model. The final model contained variables which maximized explanatory power (assessed by pseudo R2, area under the curve, and likelihood-ratio test). A risk index was created by apportioning points approximating the relative impact of variables on 1-year mortality. The Kaplan-Meier method was used to assess impact of risk score on short-term survival. Results: The 50-point scoring system incorporated 12 recipient specific variables. Derivation and validation cohort scores ranged from 0 to 33 and 0 to 27, respectively (mean 6.1 ± 3.7 and 6.1 ± 3.7). Each point increased the odds of 1-year death by 14% in the derivation cohort (odds ratio 1.14 [1.13 to 1.15], p <0.001) and 15% in the validation cohort (odds ratio 1.15 [1.12 to 1.17], p <0001). One-year survivals in the validation cohort (by increments of 3 points) were the following: 0 to 2 (92.5%); 3 to 5 (89.9%); 7 to 9 (86.3%); and 10 or greater (74.9%); p <0.001. Patients transplanted with risk scores of 20 or higher had 1-year mortality rates greater than 50%. Conclusions: We present a novel internally validated OHT recipient risk score, which is highly predictive of 1-year mortality. This risk index may prove valuable for patient prognosis, organ allocation, and research stratification in OHT.
AB - Background: No recipient risk index exists predicting short-term mortality after orthotopic heart transplantation (OHT). We utilized United Network for Organ Sharing (UNOS) data to develop a novel quantitative recipient risk score for use in OHT. Methods: A prospectively collected open cohort of 21,378 primary OHT patients (1997 to 2008) was randomly divided into subgroups. The training cohort (n = 17,079) was used for score derivation and the test cohort (n = 4,299) was used for independent validation. Recipient specific variables associated with 1-year mortality (exploratory p value <0.2) were incorporated stepwise into a multivariable logistic regression model. The final model contained variables which maximized explanatory power (assessed by pseudo R2, area under the curve, and likelihood-ratio test). A risk index was created by apportioning points approximating the relative impact of variables on 1-year mortality. The Kaplan-Meier method was used to assess impact of risk score on short-term survival. Results: The 50-point scoring system incorporated 12 recipient specific variables. Derivation and validation cohort scores ranged from 0 to 33 and 0 to 27, respectively (mean 6.1 ± 3.7 and 6.1 ± 3.7). Each point increased the odds of 1-year death by 14% in the derivation cohort (odds ratio 1.14 [1.13 to 1.15], p <0.001) and 15% in the validation cohort (odds ratio 1.15 [1.12 to 1.17], p <0001). One-year survivals in the validation cohort (by increments of 3 points) were the following: 0 to 2 (92.5%); 3 to 5 (89.9%); 7 to 9 (86.3%); and 10 or greater (74.9%); p <0.001. Patients transplanted with risk scores of 20 or higher had 1-year mortality rates greater than 50%. Conclusions: We present a novel internally validated OHT recipient risk score, which is highly predictive of 1-year mortality. This risk index may prove valuable for patient prognosis, organ allocation, and research stratification in OHT.
UR - http://www.scopus.com/inward/record.url?scp=80052806345&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=80052806345&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2011.04.030
DO - 10.1016/j.athoracsur.2011.04.030
M3 - Article
C2 - 21871277
AN - SCOPUS:80052806345
VL - 92
SP - 914
EP - 922
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 3
ER -