Department of Cardiology, Children's Hospital Boston, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
Circ Heart Fail. 2012 Mar 1;5(2):259-66. doi: 10.1161/CIRCHEARTFAILURE.111.965996. Epub 2012 Feb 3.
Risk factors for early mortality after heart transplant (HT) have not been used for quantitative risk prediction. We sought to develop and validate a risk prediction model for posttransplant in-hospital mortality in HT recipients.
We derived the model in subjects aged ≥18 years who underwent primary HT in the United States from January 2007 to June 2009 (n=4248) and validated it internally using a bootstrapping technique (200 random samples, n=4248). We then assessed the model's performance in patients receiving an HT from July 2009 to October 2010 (external validation cohort, n=2346). Posttransplant in-hospital mortality was 4.7% in the model derivation cohort. The best-fitting model based on recipient characteristics at transplant had 6 variables: age, diagnosis, type of mechanical support, ventilator support, estimated glomerular filtration rate, and total serum bilirubin. Model discrimination for survivors versus nonsurvivors was acceptable during derivation and internal validation (C statistic, 0.722 and 0.731, respectively) as was model calibration during derivation (Hosmer Lemeshow [HL] P=0.47). Model performance was reasonable in the external validation cohort (predicted mortality, 4.9%; actual mortality, 4.3%; R(2)=0.95; C statistic, 0.68; HL P=0.48). Adding the donor-related variables of age and ischemic time to the model improved its performance in both the model derivation (C statistic, 0.742; HL P=0.70) and the external validation (C statistic, 0.695; HL P=0.42) cohorts.
The proposed model allows risk stratification of HT candidates for early posttransplant mortality and may be useful in counseling patients with regard to their posttransplant prognosis. The model with additional donor-related variables may be useful during donor selection.
心脏移植（HT）后早期死亡的风险因素尚未用于定量风险预测。我们试图为 HT 受者移植后住院内死亡率开发和验证风险预测模型。
我们从 2007 年 1 月至 2009 年 6 月在美国接受原发性 HT 的年龄≥18 岁的患者中得出该模型（n=4248），并使用自举技术对其进行内部验证（200 个随机样本，n=4248）。然后，我们评估了 2009 年 7 月至 2010 年 10 月接受 HT 的患者的模型表现（外部验证队列，n=2346）。移植后住院内死亡率在模型推导队列中为 4.7%。基于移植时受者特征的最佳拟合模型有 6 个变量：年龄、诊断、机械支持类型、呼吸机支持、估计肾小球滤过率和总血清胆红素。在推导和内部验证过程中，幸存者与非幸存者之间的模型区分能力尚可（C 统计量分别为 0.722 和 0.731），在推导过程中模型校准也尚可（Hosmer Lemeshow [HL] P=0.47）。在外部验证队列中，模型性能尚可（预测死亡率 4.9%；实际死亡率 4.3%；R（2）=0.95；C 统计量 0.68；HL P=0.48）。将供体相关变量年龄和缺血时间添加到模型中，提高了模型在模型推导（C 统计量，0.742；HL P=0.70）和外部验证（C 统计量，0.695；HL P=0.42）队列中的性能。
该模型可以对 HT 候选者进行早期移植后死亡的风险分层，并且可能有助于向患者提供移植后预后方面的咨询。具有额外供体相关变量的模型可能在供体选择过程中有用。
