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A mortality risk score for septuagenarians undergoing orthotopic heart transplantation
Author(s) -
DiazCastrillon Carlos E.,
Seese Laura,
Hong Yeahwa,
Dufendach Keith,
Hickey Gavin,
Sultan Ibrahim,
Kilic Arman
Publication year - 2021
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14202
Subject(s) - medicine , framingham risk score , cohort , logistic regression , derivation , brier score , heart transplantation , odds ratio , population , transplantation , surgery , statistics , disease , mathematics , environmental health , artery
Background With septuagenarians undergoing orthotopic heart transplantation (OHT) more frequently, we aimed to develop a risk score for 1‐year mortality in this population. Methods Septuagenarian OHT recipients were identified from the UNOS registry between 1987 and 2018. The primary outcome was 1‐year post‐OHT mortality. Patients were randomly divided into derivation and validation cohorts. Associated covariates were entered into a multivariable logistic regression model. A risk score was created using the magnitudes of the odds ratios from the derivation cohort, and its 1‐year post‐OHT mortality prediction capacity was tested in the validation cohort. Results A total of 1156 septuagenarians were included, and they were randomly divided into derivation (66.7%, n = 771) and validation (33.3%, n = 385) cohorts. An 11‐point risk score incorporating 4 variables was created, which included mechanical ventilation, serum bilirubin, serum creatinine, and donor age. The predicted 1‐year mortality ranged from 4.2% (0 points) to 48.1% (11‐points) ( p < .001). After cross‐validation, the c‐index was 0.67 with a Brier score of 0.10. Risk scores above 3 points portended a survival disadvantage at 1‐year follow‐up ( p < .001). Conclusions This 11‐point risk score for septuagenarians is predictive of mortality within 1‐year of OHT and has potential utilization in improving recipient evaluation and selection of elderly patients.