Huang Wenchao, Sun Huaxin, Luo Yan, Tang Yan, Xiong Shiqiang, Long Yu, Liu Hanxiong
Department of Cardiology, The Third People's Hospital of Chengdu, College of Medicine, Southwest Jiaotong University, Chengdu, 610031, Sichuan, China.
Hellenic J Cardiol. 2025 Mar-Apr;82:54-65. doi: 10.1016/j.hjc.2023.12.003. Epub 2023 Dec 20.
We probed whether the addition of hemoglobin (HGB) or the female sex (SEX) as variables would provide additional prognostic value to the APPLE score.
An optimized APPLE score was used to evaluate the AF recurrence risk in the consecutive populations with AF post-catheter ablation including the development (n = 562) and validation (n = 239) cohorts.
In the populations of AF recurrence, most patients were female sex (103/164, 62.8%), and had the lower HGB levels. After adjusting for the APPLE score, HGB level (Odds Ratio [OR], 0.828; 95% Confidence Interval [CI], 0.749-0.915; P < 0.001) and female sex (OR, 1.596; 95% CI, 1.140-2.235; P = 0.006) independently predicted AF recurrence. Adjusting the APPLE score by HGB variable improved its predictive ability for AF recurrence (C-statistic value from 0.675 to 0.711, P = 0.010), which also increased the C-indexes in the external validation (from 0.653 to 0.725, p = 0.023). The female sex variable also enhanced the C-statistic value of the APPLE score for AF recurrence at both development and external validation (C-indices from 0.675 to 0.691, P = 0.004; C-indices from 0.653 to 0.704, p = 0.037, respectively). Decision curve analysis showed that the HGB plus APPLE score was better than the SEX plus APPLE score in predicting AF recurrence in two following AF populations.
The inclusion of HGB level and female sex variables improved the predictability and clinical usefulness of adjusted APPLE score. Adjustment of the APPLE score by HGB levels may provide better predictive value than inclusion of the female sex variable.
我们探究了将血红蛋白（HGB）或女性性别（SEX）作为变量是否会为APPLE评分提供额外的预后价值。
使用优化后的APPLE评分评估连续的导管消融术后房颤患者群体中的房颤复发风险，包括开发队列（n = 562）和验证队列（n = 239）。
在房颤复发人群中，大多数患者为女性（103/164，62.8%），且血红蛋白水平较低。在调整APPLE评分后，血红蛋白水平（比值比[OR]，0.828；95%置信区间[CI]，0.749 - 0.915；P < 0.001）和女性性别（OR，1.596；95% CI，1.140 - 2.235；P = 0.006）独立预测房颤复发。通过血红蛋白变量调整APPLE评分提高了其对房颤复发的预测能力（C统计值从0.675提高到0.711，P = 0.010），这也增加了外部验证中的C指数（从0.653提高到0.725，p = 0.023）。女性性别变量在开发队列和外部验证中也提高了APPLE评分对房颤复发的C统计值（C指数分别从0.675提高到0.691，P = 0.004；从0.653提高到0.704，p = 0.037）。决策曲线分析表明，在预测随后的两个房颤人群中的房颤复发时，血红蛋白加APPLE评分比女性性别加APPLE评分更好。
纳入血红蛋白水平和女性性别变量提高了调整后APPLE评分的可预测性和临床实用性。通过血红蛋白水平调整APPLE评分可能比纳入女性性别变量提供更好的预测价值。
