Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA.
PLoS One. 2013 Jul 17;8(7):e69160. doi: 10.1371/journal.pone.0069160. Print 2013.
The Intermountain Risk Score (IMRS), composed of the complete blood count (CBC) and basic metabolic profile (BMP), predicts mortality and morbidity in medical and general populations. Whether longitudinal repeated measurement of IMRS is useful for prognostication is an important question for its clinical applicability.
Females (N = 5,698) and males (N = 5,437) with CBC and BMP panels measured 6 months to 2.0 years apart (mean 1.0 year) had baseline and follow-up IMRS computed. Survival analysis during 4.0±2.5 years (maximum 10 years) evaluated mortality (females: n = 1,255 deaths; males: n = 1,164 deaths) and incident major events (myocardial infarction, heart failure [HF], and stroke).
Both baseline and follow-up IMRS (categorized as high-risk vs. low-risk) were independently associated with mortality (all p<0.001) in bivariable models. For females, follow-up IMRS had hazard ratio (HR) = 5.23 (95% confidence interval [CI] = 4.11, 6.64) and baseline IMRS had HR = 3.66 (CI = 2.94, 4.55). Among males, follow-up IMRS had HR = 4.28 (CI = 3.51, 5.22) and baseline IMRS had HR = 2.32 (CI = 1.91, 2.82). IMRS components such as RDW, measured at both time points, also predicted mortality. Baseline and follow-up IMRS strongly predicted incident HF in both genders.
Repeated measurement of IMRS at baseline and at about one year of follow-up were independently prognostic for mortality and incident HF among initially hospitalized patients. RDW and other CBC and BMP values were also predictive of outcomes. Further research should evaluate the utility of IMRS as a tool for clinical risk adjustment.
由全血细胞计数（CBC）和基本代谢谱（BMP）组成的山间风险评分（IMRS）可预测医疗和一般人群的死亡率和发病率。IMRS 的纵向重复测量是否对预后有用是其临床适用性的一个重要问题。
对 CBC 和 BMP 检测相隔 6 个月至 2.0 年（平均 1.0 年）的女性（N=5698）和男性（N=5437）进行了基线和随访 IMRS 计算。在 4.0±2.5 年（最长 10 年）的生存分析中评估了死亡率（女性：n=1255 例死亡；男性：n=1164 例死亡）和主要事件（心肌梗死、心力衰竭[HF]和中风）的发生率。
在双变量模型中，基线和随访 IMRS（分为高风险与低风险）均与死亡率独立相关（所有 P<0.001）。对于女性，随访 IMRS 的危险比（HR）=5.23（95%置信区间[CI]=4.11，6.64），基线 IMRS 的 HR=3.66（CI=2.94，4.55）。对于男性，随访 IMRS 的 HR=4.28（CI=3.51，5.22），基线 IMRS 的 HR=2.32（CI=1.91，2.82）。IMRS 各成分（如在两个时间点测量的红细胞分布宽度[RDW]）也可预测死亡率。基线和随访 IMRS 强烈预测了两性的 HF 事件发生率。
在最初住院的患者中，基线和大约一年随访时的 IMRS 重复测量对死亡率和 HF 发生率有独立的预后作用。RDW 和其他 CBC 和 BMP 值也具有预测作用。进一步的研究应评估 IMRS 作为临床风险调整工具的效用。
