Cardiovascular Department, Intermountain Medical Center, Salt Lake City, Utah, USA.
Transl Res. 2011 Nov;158(5):307-14. doi: 10.1016/j.trsl.2011.06.004. Epub 2011 Jul 6.
The Intermountain Risk Score (IMRS) encapsulates the mortality risk information from all components of the complete blood count (CBC) and basic metabolic profile (BMP), along with age. To individualize the IMRS more clearly, this study evaluated whether IMRS weightings for 1-year mortality predict age-specific survival over more than a decade of follow-up. Sex-specific 1-year IMRS values were calculated for general medical patients with CBC and BMP laboratory tests drawn during 1999-2005. The population was divided randomly 60% (N = 71,921, examination sample) and 40% (N = 47,458, validation sample). Age-specific risk thresholds were established, and both survival and life expectancy were compared across low-, moderate-, and high-risk IMRS categories. During 7.3 ± 1.8 years of follow-up (range, 4.5-11.1 years), the average IMRS of decedents was higher than censored in all age/sex strata (all P < 0.001). For examination and validation samples, every age stratum had incrementally lower survival for higher risk IMRS, with hazard ratios of 2.5-8.5 (P < 0.001). Life expectancies were also significantly shorter for higher risk IMRS (all P < 0.001): For example, among 50-59 year-olds, life expectancy was 7.5, 6.8, and 5.9 years for women with low-, moderate-, and high-risk IMRS (with mortality in 5.7%, 16.3%, and 37.0% of patients, respectively). In Men, life expectancy was 7.3, 6.8, and 5.4 for low-, moderate-, and high-risk IMRS (with patients having 7.3%, 19.5%, and 40.0% mortality), respectively. IMRS significantly stratified survival and life expectancy within age-defined subgroups during more than a decade of follow-up. IMRS may be used to stratify age-specific risk of mortality in research, clinical/preventive, and quality improvement applications. A web calculator is located at http://intermountainhealthcare.org/IMRS.
IMRS 囊括了完整的血细胞计数 (CBC) 和基本代谢谱 (BMP) 所有成分的死亡率风险信息，以及年龄信息。为了更清楚地个体化 IMRS，本研究评估了 1 年死亡率的 IMRS 权重是否可以预测超过 10 年随访的年龄特异性生存率。为了计算这个风险评分，对 1999-2005 年期间进行 CBC 和 BMP 实验室检查的普通内科患者进行了性别特异性 1 年 IMRS 值计算。人群被随机分为 60%（N = 71921，检查样本）和 40%（N = 47458，验证样本）。确定了年龄特异性风险阈值，并比较了低、中、高 IMRS 风险类别下的生存情况和预期寿命。在 7.3±1.8 年的随访期间（范围为 4.5-11.1 年），所有年龄/性别分层中，死亡者的平均 IMRS 均高于截尾值（均 P<0.001）。对于检查和验证样本，每个年龄组的高风险 IMRS 患者的生存率逐渐降低，风险比为 2.5-8.5（P<0.001）。较高的风险 IMRS 也显著缩短了预期寿命（均 P<0.001）：例如，在 50-59 岁的女性中，低、中、高风险 IMRS 的预期寿命分别为 7.5、6.8 和 5.9 年（死亡率分别为 5.7%、16.3%和 37.0%）。在男性中，低、中、高风险 IMRS 的预期寿命分别为 7.3、6.8 和 5.4 年（死亡率分别为 7.3%、19.5%和 40.0%）。IMRS 在超过 10 年的随访期间，在年龄定义的亚组内显著分层了生存率和预期寿命。IMRS 可用于研究、临床/预防和质量改进应用中分层特定年龄的死亡率风险。网络计算器位于 http://intermountainhealthcare.org/IMRS。
