Construction of multiple and mixed valvular heart disease-related age-adjusted comorbidity index and its predictive value for patient prognosis.

Q2 Medicine
Murong Xie, Haiyan Xu, Bin Zhang, Yunqing Ye, Zhe Li, Qingrong Liu, Zhenyan Zhao, Junxing Lyu, Yongjian Wu
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引用次数: 0

Abstract

Objectives: To create a multiple and mixed valvular heart disease (MVHD)-related age-adjusted comorbidity index (MVACI) for predicting mortality risk of patients with MVHD.

Methods: A total of 4080 patients with moderate or severe MVHD in the China-VHD study were included. The primary endpoint was 2-year all-cause mortality. A MVACI prediction model was constructed based on the mortality risk factors identified by univariate and multivariate Cox regression analysis. Restricted cubic spline curves were plotted to assess the relationship between MVACI scores and 2-year all-cause mortality. The optimal threshold, determined by the maximum Youden index from receiver operator characteristic (ROC) curve analysis, was used to stratify patients. Kaplan-Meier method was used to calculate 2-year all-cause mortality and compared using the Log-rank test. Univariate and multivariate Cox proportional hazards models were employed to calculate hazard ratios (HR) and 95% confidence intervals (CI), evaluating the association between MVACI scores and mortality. Paired ROC curves were used to compare the discriminative ability of MVACI scores with the European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE Ⅱ) or the age-adjusted Charlson comorbidity index (ACCI) in predicting 2-year clinical outcomes, while calibration curves assessed the calibration of these models. Internal validation was performed using the Bootstrap method. Subgroup analyses were conducted based on etiology, treatment strategies, and MVHD staging.

Results: Multivariate analysis identified the following comorbid conditions and age as variables independently associated with 2-year all-cause mortality in patients: pulmonary hypertension, myocardiopathy, heart failure, low body weight (body mass index<18.5 kg/m2), anaemia, hypoalbuminemia, renal insufficiency, cancer, New York Heart Association (NYHA) functional class and age. The score exhibited good discrimination (AUC=0.777, 95%CI: 0.755-0.799) and calibration (Brier score was 0.062), with significantly better predictive performance than the EuroSCORE Ⅱ or ACCI (both adjusted P<0.01). The internal validation AUC for the 2-year mortality of the MVACI model was 0.777. MVACI scores, as a continuous variable (adjusted HR=1.226, 95%CI: 1.195-1.258, P<0.01) or categorized using thresholds determined by the Yoden index (MVACI≥8 vs MVACI<8: adjusted HR=3.429, 95%CI: 2.718-4.327, P<0.01), were independently associated with 2-year mortality. The prognostic value of the score remained consistent in patients regardless of their etiology, therapeutic option, and stage of MVHD.

Conclusions: The MVACI was constructed in this study based on age and comorbidities, which can be used for mortality risk prediction and risk stratification of MVHD patients. It's a simple algorithmic index and easy to use.

多重及混合瓣膜性心脏病相关年龄调整合并症指数的构建及其对患者预后的预测价值
目的:建立一个多种和混合瓣膜性心脏病(MVHD)相关的年龄调整合并症指数(MVACI),用于预测MVHD患者的死亡风险。方法:中国- vhd研究共纳入4080例中重度MVHD患者。主要终点是2年全因死亡率。通过单因素和多因素Cox回归分析确定死亡危险因素,构建MVACI预测模型。绘制限制性三次样条曲线来评估MVACI评分与2年全因死亡率之间的关系。根据受试者操作特征(ROC)曲线分析得出的最大约登指数确定最佳阈值,对患者进行分层。采用Kaplan-Meier法计算2年全因死亡率,并采用Log-rank检验进行比较。采用单因素和多因素Cox比例风险模型计算风险比(HR)和95%置信区间(CI),评估MVACI评分与死亡率之间的关系。配对ROC曲线用于比较MVACI评分与欧洲心脏手术风险评估系统Ⅱ(EuroSCOREⅡ)或年龄校正Charlson合并症指数(ACCI)预测2年临床结果的判别能力,同时校准曲线评估这些模型的校准。使用Bootstrap方法执行内部验证。根据病因、治疗策略和MVHD分期进行亚组分析。结果:多因素分析确定了以下合并症和年龄是与患者2年全因死亡率独立相关的变量:肺动脉高血压、心肌病、心力衰竭、低体重(体重指数2)、贫血、低白蛋白血症、肾功能不全、癌症、纽约心脏协会(NYHA)功能分类和年龄。该评分具有良好的鉴别性(AUC=0.777, 95%CI: 0.755 ~ 0.799)和校准性(Brier评分为0.062),预测性能明显优于EuroSCOREⅡ或ACCI(调整后的PHR=1.226, 95%CI: 1.195 ~ 1.258, Pvs MVACIHR=3.429, 95%CI: 2.718 ~ 4.327, Pvs)。结论:本研究基于年龄和合共病构建了MVACI,可用于MVHD患者的死亡风险预测和风险分层。这是一个简单的算法索引,很容易使用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
3.80
自引率
0.00%
发文量
67
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