VanWagner et al developed a score predictive for cardiovascular risk in a patient undergoing orthotopic liver transplantation. The authors are from Northwestern University and University of Western Ontario.
Patient selection: orthotopic liver transplant (OLT)
Outcome: cardiovascular complication within 1 year (death due to CVD, hospitalization for major CVD event such as acute myocardial infarction, cardiac arrest, stroke or pulmonary embolism
Parameters:
(1) age in years
(2) sex
(3) race
(4) working status
(5) education level
(6) atrial fibrillation
(7) respiratory failure (on ventilator at time of liver transplant_
(8) pulmonary hypertension
(9) hepatocellular carcinoma (HCC)
(10) hypertension
(11) diabetes
(12) heart failure
|
Parameter |
Finding |
Points |
|
age in years |
< 45 years |
0 |
|
|
45 to 49 years |
-6 |
|
|
50 to 54 years |
-4 |
|
|
55 to 59 years |
2 |
|
|
60 to 64 years |
5 |
|
|
>= 65 years |
8 |
|
sex |
male |
0 |
|
|
female |
1 |
|
race |
black |
10 |
|
|
white |
7 |
|
|
other |
0 |
|
working status |
working for income |
0 |
|
|
not working for income |
10 |
|
education level |
high school or below |
5 |
|
|
college plus |
0 |
|
atrial fibrillation |
no |
0 |
|
|
yes |
25 |
|
respiratory failure |
no |
0 |
|
|
yes |
13 |
|
pulmonary hypertension |
no |
0 |
|
|
yes |
9 |
|
hepatocellular carcinoma |
no |
6 |
|
|
yes |
0 |
|
hypertension |
no |
0 |
|
|
yes |
4 |
|
diabetes |
no |
0 |
|
|
yes |
4 |
|
heart failure |
no |
0 |
|
|
yes |
7 |
total score =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: -6
• maximum score: 102
• The higher the score the greater the cardiovascular risk.
|
Score |
1-Year Absolute Risk |
|
<= 9 |
< 5% |
|
10 to 12 |
6% |
|
13 to 15 |
8% |
|
16 or 17 |
10% |
|
18 or 19 |
12% |
|
20 to 22 |
14% |
|
23 or 24 |
17% |
|
25 or 26 |
20% |
|
27 or 28 |
22% |
|
29 or 30 |
26% |
|
31 or 32 |
30% |
|
33 or 34 |
34% |
|
35 or 36 |
38% |
|
37 or 38 |
40% |
|
39 or 40 |
43% |
|
> 40 |
>= 45% |
Performance:
• The area under the ROC curve is 0.78.
Specialty: Cardiology
