Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation
Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation
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DOI：
10.1161/01.cir.95.12.2660
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发表时间：
1997-06-17
期刊：
影响因子：
37.8
通讯作者：
Mancini, DM
中科院分区：
文献类型：
--
作者：
Aaronson, KD;Schwartz, JS;Mancini, DM
背景：终末期充血性心力衰竭患者的危险分层是移植候选者选择过程中的一个关键组成部分。准确识别个人最有可能生存下来，而不移植将促进更有效地利用稀缺的供体organs.Methods和结果多变量比例风险生存模型开发与使用数据的80个临床特征，从268个门诊晚期心力衰竭患者（衍生样本）。构建了侵入性和非侵入性模型（有和无导管衍生数据）。从每个模型确定每个患者的预后评分。层特定的似然比被用来开发三个预测得分风险组。通过计算1年无事件生存期的受试者工作特征曲线下面积、无事件生存期的删失c指数以及比较无事件生存期曲线的统计评分风险分层，对199例相似患者（验证样本）进行前瞻性验证。结果事件定义为紧急移植或未进行移植而死亡。无创模型在两个样本中表现良好，增加导管衍生变量并不能提高性能。在衍生样本中，从非侵入性模型得出的预后评分风险组有效地对两个样本中结局事件的风险进行了分层（衍生和验证样本的1年无事件生存率分别为：低风险，93%和88%;中等风险，72%和60%;结论采用无创性风险分层模型可提高心脏移植候选者的选择。
Background Risk stratification of patients with end-stage congestive heart failure is a critical component of the transplant candidate selection process. Accurate identification of individuals most likely to survive without a transplant would facilitate more efficient use of scarce donor organs.Methods and Results Multivariable proportional hazards survival models were developed with the use of data on 80 clinical characteristics from 268 ambulatory patients with advanced heart failure (derivation sample). Invasive and noninvasive models (with and without catheterization-derived data) were constructed. A prognostic score was determined for each patient from each model. Stratum-specific likelihood ratios were used to develop three prognostic-score risk groups. The models were prospectively validated on 199 similar patients (validation sample) by calculation of the area under the receiver operating characteristic curve for 1-year event-free survival, the censored c-index for event-free survival, and comparison of event-free survival curves for prognostic-score risk strata. Outcome events were defined as urgent transplant or death without transplant. The noninvasive model performed well in both samples, and increased performance was not attained by the addition of catheterization-derived variables. Prognostic-score risk groups derived from the noninvasive model in the derivation sample effectively stratified the risk of an outcome event in both samples (1-year event-free survival for derivation and validation samples, respectively: low risk, 93% and 88%; medium risk, 72% and 60%; high risk, 43% and 35%).Conclusions Selection of candidates for cardiac transplantation may be improved by use of this noninvasive risk-stratification model.