Segovia et al reported the RADIAL score for identifying patients at risk for primary graft failure following heart transplantation. Some of the factors are known prior to surgery and so can help to identify a patient who may need more aggressive management. The authors are from Hospital Universitario Puerta de Hierro in Madrid.
Patient selection: heart transplant recipient
Outcome: primary graft failure (PGF)
Parameters and the RADIAL mneumonic:
(1) right atrial pressure in mm Hg (R)
(2) age of the transplant recipient in year (A)
(3) diabetes mellitus (D)
(4) inotrope dependence (I) prior to transplant
(5) age of donor (A)
(6) length of ischemic time in minutes (L)
|
Parameter |
Finding |
Points |
|
right atrial pressure |
< 10 mm Hg |
0 |
|
|
>= 10 mm Hg |
1 |
|
age of recipient |
< 60 years |
0 |
|
|
>= 60 years |
1 |
|
diabetes mellitus |
absent |
0 |
|
|
present |
1 |
|
inotrope dependent prior to transplant |
no |
0 |
|
|
yes |
1 |
|
age of donor |
< 30 years |
0 |
|
|
>= 30 years |
1 |
|
length of ischemic time |
< 240 minuts |
0 |
|
|
>= 240 minutes |
1 |
where:
• The timing for right atrial pressure measurement not specified but presume post-transplant.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• The risk of primary graft failure increases with increasing score.
|
Score |
Percent with PGF |
|
0 |
3% |
|
1 |
4% |
|
2 |
9% |
|
3 |
15% |
|
4 |
31% |
|
5 or 6 |
33% |
where:
• There seem to be 3 groups (0 or 1 low risk, 2 or 3 low to moderate, and 4 to 6 moderate).
Performance:
• The area under the ROC curve is 0.74.
Specialty: Cardiology, Surgery, general
