A prognostic model for predicting waiting-list mortality for a total national cohort of adult heart-transplant candidates
A prognostic model for predicting waiting-list mortality for a total national cohort of adult heart-transplant candidates
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DOI：
10.1097/01.tp.0000091171.82384.33
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发表时间：
2003-10-27
期刊：
影响因子：
6.2
通讯作者：
van Houwelingen, HC
中科院分区：
文献类型：
--
作者：
Smits, JMA;Deng, MC;van Houwelingen, HC
背景目前的趋势，在医疗管理先进的心脏衰竭和移植医学和颁布国家移植法迫使改变分配驱动的疾病严重程度。本研究的目的是建立一个模型预测等候名单生存的基础上简单的临床参数。将1997年在德国登记的所有心脏移植患者的临床资料（n=889）用作推导集，将1998年德国总队列（n=897）用作验证集。该模型通过c统计量和风险分层死亡率的比较进行了验证。通过适当的校准程序对经验证的模型进行微调。首先将数据分类为生理子评分：紧迫性评分、左心室心力衰竭评分、右心室心力衰竭评分和全身性心力衰竭评分。以这些分项分数作为因子，以及受者的年龄、ABO血型和体表面积进行逐步建模。尿急和左心室分项评分与等待名单死亡率显著相关。然后根据这两个分项评分中包含的7个参数计算一个称为德国移植协会（GTS）评分的汇总指数。GTS评分能够预测1998年队列中等待名单的死亡风险：高、中、低风险组移植前1年死亡率分别为71%、34%、11%。使用这种连续的疾病严重程度指数可能会改善心脏移植候选人的选择。
Background. Current trends in medical management of advanced heart failure and transplant medicine and the enactment of a national transplant law forced a change toward allocation driven by disease severity.Objective. The aim of this study was to create a model for predicting waiting-list survival on the basis of simple clinical parameters.Methods. The clinical profiles of all patients registered for heart transplantation in Germany in 1997 (n=889) were used as a derivation set, and the total German 1998 cohort (n=897) was used as a validation set. The model was validated by the c statistic and by comparison of risk stratified mortality rates. The validated model was fine tuned by the appropriate calibration procedures. The data were first classified into physiologic subscores: an urgency score, a left ventricular heart failure score, a right ventricular heart failure score, and a systemic heart failure score. A stepwise modeling procedure was undertaken using these subscores as factors as well as the recipient's age, ABO blood group, and body surface area.Results. The urgency and the left ventricular sub-score were found to be significantly associated with waiting-list mortality. A summary index termed German Transplant Society (GTS) score was then calculated on the basis of seven parameters contained in these two subscores. The GTS score was able to predict waiting-list mortality risks for the 1998 cohort: 1-year mortality before transplantation was 71%, 34%, 11% for the high, medium, and low risk groups, respectively.Conclusion. The use of this continuous disease severity index may improve the selection of cardiac transplant candidates.