Lily E Johnston1, Joshua C Grimm2, J Trent Magruder2, Ashish S Shah3. 1. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia. 2. Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland. 3. Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: ashish.s.shah@vanderbilt.edu.
Abstract
OBJECTIVES: The aim of this study was to develop a risk index specific to patients on mechanical circulatory support that accurately predicts 1-year mortality after orthotopic heart transplantation using the United Network for Organ Sharing database. BACKGROUND: Few clinical tools are available to aid in the decision between continuing long-term device support and performing transplantation in patients bridging with mechanical circulatory support. METHODS: Using a prospectively collected, open cohort, 6,036 patients receiving mechanical circulatory support who underwent orthotopic heart transplantation between 2000 and 2013 were evaluated and randomly separated into derivation (80%) and validation (20%) groups. Multivariate logistic regression models were constructed using variables that improved the explanatory power of the model, which was determined using multiple methods. Points for a simple additive risk index were apportioned on the basis of relative effect on odds of 1-year mortality. RESULTS: A 75-point scoring system was created from 9 recipient and 4 donor variables. The average score in the validation cohort was 14.4 ± 7.7, and scores ranged from 0 to 57; these values were similar to those in the derivation cohort. Each 1-point increase predicted an 8.3% increase in the odds of 1-year mortality (odds ratio: 1.08; 95% confidence interval: 1.06 to 1.11). Low (0 to 10), intermediate (11 to 20), and high (>20) risk score cohorts were created, with predicted average 1-year mortalities of 8.6%, 12.8%, and 31%, respectively, in the validation cohort. CONCLUSIONS: The investigators present a novel, internally cross-validated risk index that accurately predicts mortality in bridge-to-transplantation patients.
RCT Entities:
OBJECTIVES: The aim of this study was to develop a risk index specific to patients on mechanical circulatory support that accurately predicts 1-year mortality after orthotopic heart transplantation using the United Network for Organ Sharing database. BACKGROUND: Few clinical tools are available to aid in the decision between continuing long-term device support and performing transplantation in patients bridging with mechanical circulatory support. METHODS: Using a prospectively collected, open cohort, 6,036 patients receiving mechanical circulatory support who underwent orthotopic heart transplantation between 2000 and 2013 were evaluated and randomly separated into derivation (80%) and validation (20%) groups. Multivariate logistic regression models were constructed using variables that improved the explanatory power of the model, which was determined using multiple methods. Points for a simple additive risk index were apportioned on the basis of relative effect on odds of 1-year mortality. RESULTS: A 75-point scoring system was created from 9 recipient and 4 donor variables. The average score in the validation cohort was 14.4 ± 7.7, and scores ranged from 0 to 57; these values were similar to those in the derivation cohort. Each 1-point increase predicted an 8.3% increase in the odds of 1-year mortality (odds ratio: 1.08; 95% confidence interval: 1.06 to 1.11). Low (0 to 10), intermediate (11 to 20), and high (>20) risk score cohorts were created, with predicted average 1-year mortalities of 8.6%, 12.8%, and 31%, respectively, in the validation cohort. CONCLUSIONS: The investigators present a novel, internally cross-validated risk index that accurately predicts mortality in bridge-to-transplantation patients.