Simple Score to Assess the Risk of Rejection After Orthotopic Heart Transplantation
Simple Score to Assess the Risk of Rejection After Orthotopic Heart Transplantation
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DOI：
10.1161/circulationaha.111.066431
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发表时间：
2012-06-19
期刊：
影响因子：
37.8
通讯作者：
Yuh, David D.
中科院分区：
文献类型：
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作者：
Kilic, Arman;Weiss, Eric S.;Yuh, David D.
背景：本研究的目的是推导和验证原位心脏移植后排斥反应的风险评分。方法和结果：使用器官共享联合网络登记系统对1998年至2008年间接受原位心脏移植的患者进行识别。共有14 265名符合条件的患者被随机分为衍生组（80%,n = 11 412）和验证组（20%,n = 2853）。主要结果为原位心脏移植术后1年内药物治疗排斥反应。发现与排斥相关的协变量（探索性单变量P < 0.2）被输入到多变量逻辑回归模型中。通过改进McFadden伪r -2、似然比检验和c指数来评估模型中每个变量的纳入情况。然后通过使用衍生队列的相对比值比产生风险评分，并在验证队列中独立测试其预测排斥反应的能力。建立了包含4个变量（年龄、种族、性别、HLA匹配）的13分风险评分。推导组和验证组的平均得分分别为8.3 +/- 2.2和8.4 +/- 2.1。基于衍生队列的预测1年排斥率从16.2%（评分= 0）到50.7%（评分= 13;P < 0.001）。在加权回归分析中，这些预测排斥率与验证队列中实际观察到的排斥率之间存在很强的相关性（r(2) = 0.96, P < 0.001）。Logistic回归分析也显示了显著的相关性（优势比，1.13;P < 0.001）。在推导组和验证组中，综合评分的c指数相等（c = 0.67）。结论：这一新的13分风险评分可高度预测原位心脏移植术后1年内临床显著排斥反应的发生。它在调整免疫抑制方案和原位心脏移植研究分层方面具有潜在的应用价值。（Circulation. 2012; 125: 3013-3021）
Background-The aim of this study was to derive and validate a risk score for rejection after orthotopic heart transplantation.Methods and Results-The United Network for Organ Sharing registry was used to identify patients undergoing orthotopic heart transplantation between 1998 and 2008. A total of 14 265 eligible patients were randomly divided into derivation (80%; n = 11 412) and validation (20%; n = 2853) cohorts. The primary outcome was drug-treated rejection within 1 year of orthotopic heart transplantation. Covariates found to be associated (exploratory univariate P < 0.2) with rejection were entered into a multivariable logistic regression model. Inclusion of each variable in the model was assessed by improvement in the McFadden pseudo-R-2, likelihood ratio test, and c index. A risk score was then generated through the use of relative magnitudes of the odds ratios from the derivation cohort, and its ability to predict rejection was tested independently in the validation cohort. A 13-point risk score incorporating 4 variables (age, race, sex, HLA matching) was created. The mean scores in the derivation and validation cohorts were 8.3 +/- 2.2 and 8.4 +/- 2.1, respectively. Predicted 1-year rejection rates based on the derivation cohort ranged from 16.2% (score = 0) to 50.7% (score = 13; P < 0.001). In weighted regression analysis, there was a strong correlation between these predicted rates of rejection and actual, observed rejection rates in the validation cohort (r(2) = 0.96, P < 0.001). Logistic regression analysis also demonstrated a significant association (odds ratio, 1.13; P < 0.001). The c index of the composite score was equivalent in both the derivation and validation cohorts (c = 0.67).Conclusions-This novel 13-point risk score is highly predictive of clinically significant rejection episodes within 1 year of orthotopic heart transplantation. It has potential utility in tailoring immunosuppressive regimens and in research stratification in orthotopic heart transplantation. (Circulation. 2012; 125: 3013-3021.)