Weiss et al described the IMPACT score for recipients of heart transplants. This can help to identify a patient who may benefit from more aggressive management or who may not be an ideal candidate for transplant. The authors are from the Johns Hopkins University.
IMPACT = index for mortality prediction after cardiac transplantation
Patient selection: heart transplant recipient
Parameters:
(1) age of the patient in years
(2) gender
(3) serum total bilirubin in mg/dL
(4) creatinine clearance in mL per minute
(5) dialysis between listing and transplant
(6) heart failure etiology
(7) race
(8) infection
(9) IABP (intra-aortic balloon pump)
(10) mechanical ventilation prior to transplant
(11) race
(12) temporary circulatory support (ECMO, extracorporeal)
(13) ventricular assist device (VAD)
|
Parameter |
Finding |
Points |
|
age of the patient |
<= 60 years |
0 |
|
|
> 60 years |
3 |
|
gender |
male |
0 |
|
|
female |
3 |
|
serum total bilirubin |
< 1 mg/dL |
0 |
|
|
1 to 1.99 mg/dL |
1 |
|
|
2 to 3.99 mg/dL |
3 |
|
|
>= 4 mg/dL |
4 |
|
creatinine clearance |
>=-2.75) 50 mL per minute |
0 |
|
|
30 to 49 mL per min |
2 |
|
|
< 30 mL per minute |
5 |
|
dialysis |
no |
0 |
|
|
yes |
4 |
|
heart failure etiology |
idiopathic |
0 |
|
|
ischemic |
2 |
|
|
congenital |
5 |
|
|
other |
1 |
|
infection |
no |
0 |
|
|
yes |
3 |
|
IABP |
no |
0 |
|
|
yes |
3 |
|
mechanical ventilation |
no |
0 |
|
|
yes |
5 |
|
race |
Caucasian |
0 |
|
|
African American |
3 |
|
|
Hispanic |
0 |
|
|
other |
0 |
|
temporary circulatory support |
no |
0 |
|
|
yes |
7 |
|
VAD |
older gen pulsatile |
3 |
|
|
Heartmate II |
0 |
|
|
other new generation continuous |
5 |
|
|
none |
0 |
total score =
= SUM(points for all 13 parameters)
Interpretation:
• minimum score: 0
• maximum score: 50
• The higher the score the lower the 1-year survival rate.
• Scores above 20 are uncommon.
|
Total Score |
1 Year Survival |
|
0 to 2 |
93% |
|
3 to 5 |
90% |
|
7 to 9 |
86% |
|
10 to 19 |
75% |
|
20 to 50 |
< 50% |
X =
= (0.13 * (IMPACT)) - 2.75
probability of one year mortality =
= 1 / (1 + EXP((-1) * X))
Specialty: Cardiology, Surgery, general
