Risk Score for Predicting 2-Year Mortality in Patients With Chagas Cardiomyopathy From Endemic Areas: SaMi-Trop Cohort Study
Risk Score for Predicting 2-Year Mortality in Patients With Chagas Cardiomyopathy From Endemic Areas: SaMi-Trop Cohort Study
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DOI：
10.1161/jaha.119.014176
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发表时间：
2020-03-17
影响因子：
5.4
通讯作者：
Ribeiro, Antonio Luiz P.
中科院分区：
文献类型：
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作者：
Oliveira, Claudia Di Lorenzo;Nunes, Maria Carmo P.;Ribeiro, Antonio Luiz P.
在资源有限的情况下，对恰加斯病患者进行风险分层将有助于制定管理策略。我们开发了一个评分来预测2年的死亡率在查加斯心肌病患者从偏远的地方性areas.Methods和ResultsThis研究纳入1551例查加斯心肌病患者从米纳斯吉拉斯州，巴西，从萨米-Trop队列（圣保罗-米纳斯吉拉斯热带医学研究中心）。进行临床评价、ECG和NT-proBNP（N-末端B型利钠肽前体）。使用考克斯比例风险模型开发基于关键预测因子的预测模型。终点为全因死亡率。患者在基线时被分为3个风险类别（低，= 2%至10%;高，>= 10%）。通过将评分应用于患有恰加斯病的独立人群进行外部验证。随访2年后，110例患者死亡，总死亡率为3.505例/100人年。根据列线图，死亡率的独立预测因素被分配了分数：年龄（每十年10分），纽约心脏协会心功能分级高于I（15分），心率>= 80次/分（20分），QRS时限>= 150 ms（15分），以及经年龄调整的NT-proBNP异常（55分）。在推导队列中观察到的低、中、高风险组的死亡率分别为0%、3.6%和32.7%，在验证队列中分别为3.2%、8.7%和19.1%。在发展队列（C统计量：0.82）和验证队列（C统计量：0.71）的分数的歧视是很好的。结论在一个大的人群中，查加斯心肌病患者的风险因素的组合准确地预测早期死亡率。这种简单的评分方法可以在技术资源有限的偏远地区使用。
BackgroundRisk stratification of Chagas disease patients in the limited-resource setting would be helpful in crafting management strategies. We developed a score to predict 2-year mortality in patients with Chagas cardiomyopathy from remote endemic areas.Methods and ResultsThis study enrolled 1551 patients with Chagas cardiomyopathy from Minas Gerais State, Brazil, from the SaMi-Trop cohort (The Sao Paulo-Minas Gerais Tropical Medicine Research Center). Clinical evaluation, ECG, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) were performed. A Cox proportional hazards model was used to develop a prediction model based on the key predictors. The end point was all-cause mortality. The patients were classified into 3 risk categories at baseline (low, = 2% to 10%; high, >= 10%). External validation was performed by applying the score to an independent population with Chagas disease. After 2 years of follow-up, 110 patients died, with an overall mortality rate of 3.505 deaths per 100 person-years. Based on the nomogram, the independent predictors of mortality were assigned points: age (10 points per decade), New York Heart Association functional class higher than I (15 points), heart rate >= 80 beats/min (20 points), QRS duration >= 150 ms (15 points), and abnormal NT-proBNP adjusted by age (55 points). The observed mortality rates in the low-, intermediate-, and high-risk groups were 0%, 3.6%, and 32.7%, respectively, in the derivation cohort and 3.2%, 8.7%, and 19.1%, respectively, in the validation cohort. The discrimination of the score was good in the development cohort (C statistic: 0.82), and validation cohort (C statistic: 0.71).ConclusionsIn a large population of patients with Chagas cardiomyopathy, a combination of risk factors accurately predicted early mortality. This helpful simple score could be used in remote areas with limited technological resources.