An easily calculable and highly predictive risk index for postoperative renal failure after heart transplantation
An easily calculable and highly predictive risk index for postoperative renal failure after heart transplantation
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DOI：
10.1016/j.jtcvs.2014.05.065
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发表时间：
2014-09-01
影响因子：
6
通讯作者：
Sciortino, Christopher M.
中科院分区：
文献类型：
--
作者：
Kilic, Arman;Grimm, Joshua C.;Sciortino, Christopher M.
目的：本研究推导并验证了一个风险指数为术后肾功能衰竭后原位hearttransplantation.Methods：成人原位心脏移植2000年和2010年之间进行了确定在器官共享的联合网络数据库。患者以4：1的比例随机分为推导队列和验证队列。主要结局是新发术后肾衰竭，需要透析。建立多变量模型，在单变量分析中纳入与肾功能衰竭相关的变量，根据比值比分配重要风险因素。一个简单的指南，以证明与临床意义的肾功能衰竭rates.Results：共14,635原位心脏移植受体的风险评分范围。1128例患者（7.7%）发生新发术后肾功能衰竭。使用13个显著风险因素生成100分风险评分。验证队列中的实际肾衰竭发生率与基于风险评分的推导队列中的预测发生率之间存在高度相关性（r = 0.91，P <0.001）。肾衰竭风险类别是根据推导队列中确定的概率生成的：低（< 5%风险，评分0-15）、平均（5%-10%风险，评分16-26）、高于平均（10%-20%风险，评分27-39）和高（>20%风险，评分>= 40）。验证队列中这些风险评分范围的实际肾衰竭发生率对应于其分配的风险类别：评分0 - 15（发生率4.1%），评分16 - 26（发生率6.8%），得分27 - 39（13.2%），得分40或以上（20.2%）。这一包含13个危险因素的100点风险指数高度预测原位心脏移植术后新发的术后肾功能衰竭。使用基于评分范围生成的风险类别对原位心脏移植受者进行前瞻性评估可能有助于定制围手术期管理。
Objectives: This study derived and validated a risk index for postoperative renal failure after orthotopic heart transplantation.Methods: Adult orthotopic heart transplantations performed between 2000 and 2010 were identified in the United Network for Organ Sharing database. Patients were randomly divided 4: 1 into derivation and validation cohorts. The primary outcome was new-onset postoperative renal failure requiring dialysis. A multivariable model was created incorporating variables associated with renal failure in univariate analysis, with significant risk factors assigned points based on odds ratios. A simple guide was generated to demonstrate ranges of risk scores associated with clinically meaningful renal failure rates.Results: A total of 14,635 orthotopic heart transplantation recipients were included. New-onset postoperative renal failure occurred in 1128 patients (7.7%). A 100-point risk score was generated using 13 significant risk factors. There was a high degree of correlation between actual renal failure rates in the validation cohort and predicted rates in the derivation cohort based on risk scores (r = 0.91, P < .001). Renal failure risk categories were generated on the basis of probabilities determined in the derivation cohort: low (< 5% risk, score 0-15), average (5%-10% risk, score 16-26), above average (10%-20% risk, score 27-39), and high (>20% risk, score >= 40). The actual renal failure rates in the validation cohort for these risk score ranges corresponded to the risk category they were assigned to: score 0 to 15 (4.1% rate), score 16 to 26 (6.8% rate), score 27 to 39 (13.2% rate), and score 40 or more (20.2% rate).Conclusions: This 100-point risk index incorporating 13 risk factors is highly predictive of new-onset postoperative renal failure after orthotopic heart transplantation. Prospective assessment of orthotopic heart transplant recipients using the risk categories that were generated on the basis of score ranges may help in tailoring perioperative management.