A mortality risk score for septuagenarians undergoing orthotopic heart transplantation.
cardiac transplant
recipient age
risk score
septuagenarian
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
revised:
30
11
2020
received:
30
09
2020
accepted:
07
12
2020
pubmed:
29
12
2020
medline:
2
7
2021
entrez:
28
12
2020
Statut:
ppublish
Résumé
With septuagenarians undergoing orthotopic heart transplantation (OHT) more frequently, we aimed to develop a risk score for 1-year mortality in this population. Septuagenarian OHT recipients were identified from the UNOS registry between 1987 and 2018. The primary outcome was 1-year post-OHT mortality. Patients were randomly divided into derivation and validation cohorts. Associated covariates were entered into a multivariable logistic regression model. A risk score was created using the magnitudes of the odds ratios from the derivation cohort, and its 1-year post-OHT mortality prediction capacity was tested in the validation cohort. A total of 1156 septuagenarians were included, and they were randomly divided into derivation (66.7%, n = 771) and validation (33.3%, n = 385) cohorts. An 11-point risk score incorporating 4 variables was created, which included mechanical ventilation, serum bilirubin, serum creatinine, and donor age. The predicted 1-year mortality ranged from 4.2% (0 points) to 48.1% (11-points) (p < .001). After cross-validation, the c-index was 0.67 with a Brier score of 0.10. Risk scores above 3 points portended a survival disadvantage at 1-year follow-up (p < .001). This 11-point risk score for septuagenarians is predictive of mortality within 1-year of OHT and has potential utilization in improving recipient evaluation and selection of elderly patients.
Sections du résumé
BACKGROUND
With septuagenarians undergoing orthotopic heart transplantation (OHT) more frequently, we aimed to develop a risk score for 1-year mortality in this population.
METHODS
Septuagenarian OHT recipients were identified from the UNOS registry between 1987 and 2018. The primary outcome was 1-year post-OHT mortality. Patients were randomly divided into derivation and validation cohorts. Associated covariates were entered into a multivariable logistic regression model. A risk score was created using the magnitudes of the odds ratios from the derivation cohort, and its 1-year post-OHT mortality prediction capacity was tested in the validation cohort.
RESULTS
A total of 1156 septuagenarians were included, and they were randomly divided into derivation (66.7%, n = 771) and validation (33.3%, n = 385) cohorts. An 11-point risk score incorporating 4 variables was created, which included mechanical ventilation, serum bilirubin, serum creatinine, and donor age. The predicted 1-year mortality ranged from 4.2% (0 points) to 48.1% (11-points) (p < .001). After cross-validation, the c-index was 0.67 with a Brier score of 0.10. Risk scores above 3 points portended a survival disadvantage at 1-year follow-up (p < .001).
CONCLUSIONS
This 11-point risk score for septuagenarians is predictive of mortality within 1-year of OHT and has potential utilization in improving recipient evaluation and selection of elderly patients.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14202Informations de copyright
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Bleumink G, Knetsch A, Sturkenboom M, et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure the Rotterdam study. Eur Heart J. 2004;25(18):1614-1619.
Lloyd-Jones DM, Larson MG, Leip EP, et al. Lifetime risk for developing congestive heart failure. Circulation. 2002;106(24):3068-3072.
Adamson RM, Stahovich M, Chillcott S, et al. Clinical strategies and outcomes in advanced heart failure patients older than 70 years of age receiving the HeartMate II left ventricular assist device. J Am Coll Cardiol. 2011;57(25):2487-2495.
Kilic A, Weiss ES, Yuh DD, Shah AS, Conte JV. Factors associated with 5-year survival in older heart transplant recipients. J Thorac Cardiovasc Surg. 2012;143(2):468-474.
Demers P, Moffatt S, Oyer PE, Hunt SA, Reitz BA, Robbins RC. Long-term results of heart transplantation in patients older than 60 years. J Thoracic Cardiovasc Surg. 2003;126(1):224-231.
George TJ, Kilic A, Beaty CA, Conte JV, Mandal K, Shah AS. Septuagenarians bridged to heart transplantation with a ventricular assist device have outcomes similar to younger patients. Ann Thorac Surg. 2013;95(4):1251-1261.
Mehra MR, Canter CE, Hannan MM, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update. J Hear Lung Transplant. 2016;35(1):1-23.
Cooper LB, Lu D, Mentz RJ, et al. Cardiac transplantation for older patients: characteristics and outcomes in the septuagenarian population. J Hear Lung Transplant. 2016;35(3):362-369.
Steyerberg EW, Harrell FE, Borsboom GJJ, Eijkemans MJ, Vergouwe Y, Habbema JDF. Internal validation of predictive models. J Clin Epidemiol. 2001;54(8):774-781.
Weiss ES, Allen JG, Kilic A, et al. Development of a quantitative donor risk index to predict short-term mortality in orthotopic heart transplantation. J Hear Lung Transplant. 2012;31(3):266-273.
Kilic A, Grimm JC, Shah AS, Conte JV, Whitman GJR, Sciortino CM. An easily calculable and highly predictive risk index for postoperative renal failure after heart transplantation. J Thorac Cardiovasc Surg. 2010;148(3):1099-1105.
Weiss ES, Allen JG, Arnaoutakis GJ, et al. Creation of a quantitative recipient risk Index for Mortality Prediction After Cardiac Transplantation (IMPACT). Ann Thorac Surg. 2011;92(3):914-922.
Joyce DL, Li Z, Edwards LB, Kobashigawa JA, Daly RC. Predicting 1-year cardiac transplantation survival using a donor-recipient risk-assessment tool. J Thorac Cardiovasc Surg. 2018;155(4):1580-1590.
Singh TP, Almond CS, Semigran MJ, Piercey G, Gauvreau K. Risk prediction for early in-hospital mortality following heart transplantation in the United States. Circ Hear Fail. 2012;5(2):259-266.
Sorabella RA, Guglielmetti L, Kantor A, et al. Cardiac donor risk factors predictive of short-term heart transplant recipient mortality: an analysis of the United Network for organ sharing database. Transplant Proc. 2015;47(10):2944-2951.
Zuckermann A. Long-term survival (%3e10 years) of patients %3e60 years with induction therapy after cardiac transplantation. Eur J Cardio-Thoracic Surg. 2003;24(2):283-291.
Nagendran J, Wildhirt SM, Modry D, Mullen J, Koshal A, Wang SH. A comparative analysis of outcome after heart transplantation in patients aged 60 years and older: the University of Alberta experience. J Card Surg. 2004;19(6):559-562.