Validation of existing risk scores for mortality prediction after a heart transplant in a Chinese population. (8th January 2022)

• Record Type: Journal Article
• Authors: Zheng, Shanshan; Tang, Hanwei; Zheng, Zhe; Song, Yunhu; Huang, Jie; Liao, Zhongkai; Liu, Sheng
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 34:Number 5(2022)
• Page Start: 909
• Page End: 918
• Publication Date: 2022-01-08
• Subjects: Heart transplant -- UNOS -- IMPACT -- RSS -- Risk scores -- Post-transplant mortality; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivab380
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: The objectives of this study were to validate 3 existing heart transplant risk scores with a single-centre cohort in China and evaluate the efficacy of the 3 systems in predicting mortality. METHODS: We retrospectively studied 428 patients from a single centre who underwent heart transplants from January 2015 to December 2019. All patients were scored using the Index for Mortality Prediction After Cardiac Transplantation (IMPACT) and the United Network for Organ Sharing (UNOS) and risk stratification scores (RSSs). We assessed the efficacy of the risk scores by comparing the observed and the predicted 1-year mortality. Binary logistic regression was used to evaluate the predictive accuracy of the 3 risk scores. Model discrimination was assessed by measuring the area under the receiver operating curves. Kaplan–Meier survival analyses were performed after the patients were divided into different risk groups. RESULTS: Based on our cohort, the observed mortality was 6.54%, whereas the predicted mortality of the IMPACT and UNOS scores and the RSSs was 10.59%, 10.74% and 12.89%, respectively. Logistic regression analysis showed that the IMPACT [odds ratio (OR), 1.25; 95% confidence interval (CI), 1.15–1.36; P < 0.001], UNOS (OR, 1.68; 95% CI, 1.37–2.07; P < 0.001) and risk stratification (OR, 1.61; 95% CI, 1.30–2.00; P < 0.001) scores were predictive of 1-year mortality. The discriminative power was numerically higher for the IMPACT score [area under the curve (AUC) of 0.691)] than for the UNOS score (AUC 0.685) and the RSS (AUC 0.648). CONCLUSIONS: We validated the IMPACT and UNOS scores and the RSSs as predictors of 1-year mortality after a heart transplant, but all 3 risk scores had unsatisfactory discriminative powers that overestimated the observed mortality for the Chinese cohort. Abstract : In the past decade, the number of patients listed for cardiac transplants has increased considerably, but the number of available organs is inadequate [1–3].