Murphy Rachel D, Park Sarah Y, Allen Larry A, Ambardekar Amrut V, Cleveland Joseph C, Cain Michael T, Kaplan Bruce, Hoffman Jordan R H, Malamon John S
Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
JACC Adv. 2024 Dec 13;4(1):101449. doi: 10.1016/j.jacadv.2024.101449. eCollection 2025 Jan.
Currently, there is no mathematical model used nationally to determine the medical urgency of patients on the heart transplant waitlist in the United States. While the current organ distribution system accounts for many patient factors, a truly objective model is needed to more reliably stratify patients by their medical acuity.
The aim of the study was to develop risk scores (Colorado Heart failure Acuity Risk Model [CHARM] score) to predict mortality in adults waitlisted for heart transplant.
Risk scores were based on multivariable logistic regression models with mortality endpoints at 90 days, 180 days, 1 year, and 2 years. The models included serology data and patient history variables from waitlisted patients (N = 4,176) within the Scientific Registry of Transplant Recipients database from January 1, 2017, to September 2, 2023.
The CHARM score included serum markers (brain natriuretic peptide, creatinine, sodium, aspartate aminotransferase, albumin, total bilirubin) and clinical variables (history of cardiac surgery, prior transplant, willingness to accept an hepatitis C virus positive heart, use of extracorporeal membrane oxygenation, use of mechanical life support, implantation of a cardiac defibrillator, and ventilator support prior to transplant). Sample holdout-validation for the models yielded average area under the curves of 0.825 (90-day), 0.805 (180-day), 0.779 (1-year), and 0.766 (2-year). Risk indices for all models were 99% correlated with observed mortality rates.
The CHARM score provides reliable calibration and prediction, offering an objective system for identifying critically ill patients on the heart transplant waitlist. The CHARM score will be useful in the era of continuous distribution to standardize organ allocation.
目前，美国尚无全国性的数学模型用于确定心脏移植等候名单上患者的医疗紧急程度。虽然当前的器官分配系统考虑了许多患者因素，但仍需要一个真正客观的模型来更可靠地根据患者的医疗敏锐度对其进行分层。
本研究的目的是开发风险评分（科罗拉多心力衰竭敏锐度风险模型[CHARM]评分），以预测等待心脏移植的成年人的死亡率。
风险评分基于多变量逻辑回归模型，其死亡率终点分别为90天、180天、1年和2年。这些模型纳入了2017年1月1日至2023年9月2日移植受者科学登记数据库中等待名单上患者（N = 4176）的血清学数据和患者病史变量。
CHARM评分包括血清标志物（脑钠肽、肌酐、钠、天冬氨酸转氨酶、白蛋白、总胆红素）和临床变量（心脏手术史、既往移植史、接受丙型肝炎病毒阳性心脏的意愿、体外膜肺氧合的使用、机械生命支持的使用、心脏除颤器的植入以及移植前的呼吸机支持）。模型的样本保留验证得出曲线下平均面积分别为0.825（90天）、0.805（180天）、0.779（1年）和0.766（2年）。所有模型的风险指数与观察到的死亡率的相关性均为99%。
CHARM评分提供了可靠的校准和预测，为识别心脏移植等候名单上的重症患者提供了一个客观系统。在持续分配的时代，CHARM评分将有助于规范器官分配。
