Cardiovascular Department, Intermountain Medical Center, 5121 S. Cottonwood St., Salt Lake City, UT 84107, USA.
Eur J Heart Fail. 2010 Nov;12(11):1203-13. doi: 10.1093/eurjhf/hfq115. Epub 2010 Aug 12.
The complete blood count (CBC) and basic metabolic profile are common, low-cost blood tests, which have previously been used to create and validate the Intermountain Risk Score (IMRS) for mortality prediction. Mortality is the most definitive clinical endpoint, but medical care is more easily applied to modify morbidity and thereby prevent death. This study tested whether IMRS is associated with clinical morbidity endpoints.
Patients seen for coronary angiography (n = 3927) were evaluated using a design similar to a genome-wide association study. The Bonferroni correction for 102 tests required a P-value of ≤ 4.9 × 10⁻⁴ for significance. A second set of angiography patients (n = 10 413) was used to validate significant findings from the first patient sample. In the first patient sample, IMRS predicted heart failure (HF) (P(trend) = 1.6 × 10(-26)), coronary disease (P(trend) = 2.6 × 10(-11)), myocardial infarction (MI) (P(trend) = 3.1 × 10(-25)), atrial fibrillation (P(trend) = 2.5 × 10(-20)), and chronic obstructive pulmonary disease (P(trend) = 4.7 × 10⁻⁴). Even more, IMRS predicted HF readmission [hazard ratio (HR) = 2.29/category, P(trend) = 1.2 × 10⁻⁶), incident HF (HR = 1.88/category, P(trend) = 0.02), and incident MI (HR = 1.56/category, P(trend) = 4.7 × 10⁻⁴). These findings were verified in the second patient sample.
Intermountain Risk Score, a predictor of mortality, was associated with morbidity endpoints that often lead to mortality. Further research is required to fully characterize its clinical utility, but its low-cost CBC and basic metabolic profile composition may make it ideal for initial risk estimation and prevention of morbidity and mortality. An IMRS web calculator is freely available at http://intermountainhealthcare.org/IMRS.
全血细胞计数（CBC）和基本代谢谱是常见的低成本血液检测，以前曾用于创建和验证死亡率预测的山间风险评分（IMRS）。死亡率是最明确的临床终点，但医疗更便于应用于改善发病率，从而预防死亡。本研究测试了 IMRS 是否与临床发病率终点相关。
对接受冠状动脉造影检查的患者（n = 3927）进行评估，设计类似于全基因组关联研究。为了达到统计学意义，需要对 102 个测试进行 Bonferroni 校正，要求 P 值≤4.9×10⁻⁴。对第二组接受冠状动脉造影检查的患者（n = 10413）进行验证，以验证第一组患者样本中的显著发现。在第一组患者样本中，IMRS 预测心力衰竭（HF）（P趋势= 1.6×10⁻²⁶）、冠状动脉疾病（P趋势= 2.6×10⁻¹¹）、心肌梗死（MI）（P趋势= 3.1×10⁻²⁵）、心房颤动（P趋势= 2.5×10⁻²⁰）和慢性阻塞性肺疾病（P趋势= 4.7×10⁻⁴）。更重要的是，IMRS 还预测了心力衰竭再入院[风险比（HR）= 2.29/类别，P趋势= 1.2×10⁻⁶]、心力衰竭首发事件（HR = 1.88/类别，P趋势= 0.02）和心肌梗死首发事件（HR = 1.56/类别，P趋势= 4.7×10⁻⁴）。这些发现也在第二组患者样本中得到了验证。
死亡率预测指标山间风险评分（IMRS）与常导致死亡的发病率终点相关。需要进一步研究以充分描述其临床应用价值，但它的低成本 CBC 和基本代谢谱组成可能使其成为初始风险评估和发病率及死亡率预防的理想选择。一个 IMRS 网络计算器可在 http://intermountainhealthcare.org/IMRS 免费获得。
