Mark A Hlatky1, David Shilane2, Tara I Chang2, Derek Boothroyd2, Alan S Go3. 1. Stanford University School of Medicine, Stanford, CA. Electronic address: hlatky@stanford.edu. 2. Stanford University School of Medicine, Stanford, CA. 3. Division of Research, Kaiser Permanente of Northern California, Oakland, CA; University of California, San Francisco, San Francisco, CA.
Abstract
BACKGROUND: Prognostic factors are usually evaluated by their statistical significance rather than by their clinical utility. Risk reclassification measures the extent to which a novel marker adds useful information to a prognostic model. The extent to which estimated glomerular filtration rate (eGFR) adds information about prognosis among patients with coronary heart disease is uncertain. METHODS: We studied patients in an integrated health care delivery system with newly diagnosed coronary heart disease. We developed a model of the risk of death over 2 years of follow-up and then added eGFR to the model and measured changes in C-index, net reclassification improvement, and integrated discrimination improvement. RESULTS: Almost half of the 31,533 study patients had reduced eGFR (<60 mL/min per 1.73 m(2)). Mortality was significantly higher among patients who had lower levels of eGFR, even after adjustment for baseline characteristics (P < .0001). The addition of eGFR to the prognostic model increased the C-index from 0.837 to 0.843, the net reclassification improvement by 3.2% (P < .0001), and integrated discrimination improvement by 1.3% (P = .007). CONCLUSION: Estimated glomerular filtration rate is an informative prognostic factor among patients with incident coronary heart disease, independent of other clinical characteristics.
BACKGROUND: Prognostic factors are usually evaluated by their statistical significance rather than by their clinical utility. Risk reclassification measures the extent to which a novel marker adds useful information to a prognostic model. The extent to which estimated glomerular filtration rate (eGFR) adds information about prognosis among patients with coronary heart disease is uncertain. METHODS: We studied patients in an integrated health care delivery system with newly diagnosed coronary heart disease. We developed a model of the risk of death over 2 years of follow-up and then added eGFR to the model and measured changes in C-index, net reclassification improvement, and integrated discrimination improvement. RESULTS: Almost half of the 31,533 study patients had reduced eGFR (<60 mL/min per 1.73 m(2)). Mortality was significantly higher among patients who had lower levels of eGFR, even after adjustment for baseline characteristics (P < .0001). The addition of eGFR to the prognostic model increased the C-index from 0.837 to 0.843, the net reclassification improvement by 3.2% (P < .0001), and integrated discrimination improvement by 1.3% (P = .007). CONCLUSION: Estimated glomerular filtration rate is an informative prognostic factor among patients with incident coronary heart disease, independent of other clinical characteristics.
Authors: M Moscucci; E Kline-Rogers; D Share; M O'Donnell; A Maxwell-Eward; W L Meengs; P Kraft; A C DeFranco; J L Chambers; K Patel; J G McGinnity; K A Eagle Journal: Circulation Date: 2001-07-17 Impact factor: 29.690
Authors: Alan S Go; Carlos Iribarren; Malini Chandra; Phenius V Lathon; Stephen P Fortmann; Thomas Quertermous; Mark A Hlatky Journal: Ann Intern Med Date: 2006-02-21 Impact factor: 25.391
Authors: Alan S Go; Elaine M Hylek; Yuchiao Chang; Kathleen A Phillips; Lori E Henault; Angela M Capra; Nancy G Jensvold; Joe V Selby; Daniel E Singer Journal: JAMA Date: 2003-11-26 Impact factor: 56.272