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Pulmonary Physiology |

Pulmonary-Specific Intermountain Risk Score: Derivation and Validation of Risk Scores for Mortality Among Patients Undergoing Pulmonary Function Testing

Benjamin Horne*, PhD; Matthew Hegewald, MD; Joseph Muhlestein, MD; Elizabeth Huggins, RN; Heidi May, PhD; Tami Bair, BS; Jeffrey Anderson, MD
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Intermountain Heart Institute, Salt Lake City, UT


Chest. 2012;142(4_MeetingAbstracts):785A. doi:10.1378/chest.1390727
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Abstract

SESSION TYPE: Physiology/PFTs/ Rehabilitation I

PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM

PURPOSE: Forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) are known predictors of coronary heart disease and mortality. Previously we created and validated risk scores using all risk information in the basic metabolic profile (BMP) and the complete blood count (CBC). This study created and tested risk scores for mortality combining BMP, CBC, and pulmonary function testing (PFT) data.

METHODS: Of those patients evaluated by PFT between October, 2002, and October, 2011, 70% (females: n=2,056; males: n=1,754) were included in deriving risk scores using the FVC, body mass index, age, and laboratory factors (similar models using the FEV1 instead of FVC were also created). Sex-specific risk scores included BMP and PFT data (pulmonary BMP Risk Score, pBRS) or BMP, CBC, and PFT (pulmonary Intermountain Risk Score, pIMRS). Cox regression was used to determine multivariable contributions of independent variables to the risk of all-cause mortality following PFT. A scalar risk score was then created using the regression beta-coefficients for each variable. The other 30% of PFT patients were held aside as an internal independent set of patients for validating the risk scores (females: n=887, males: n=741).

RESULTS: In the derivation and validation samples, females averaged 59.4±15.4 years and 58.6±14.9 years of age, respectively, and males were 60.2±15.2 years and 60.5±15.0 years of age. For pBRS in females, 6.9% of patients died (derivation) and 7.9% (validation), and areas under the curve (AUC) were 0.815 and 0.806, respectively. Mortality among males was 12.1% in derivation and 10.1% in validation patients, with AUCs of 0.734 and 0.731, respectively, for pBRS. CBC data were available on half of patients, with pIMRS AUCs of 0.835 and 0.757 for females in derivation and validation, and AUCs of 0.755 and 0.699 among males, respectively. Risk scores utilizing FEV1 instead of FVC had slightly better AUCs for males.

CONCLUSIONS: Risk scores encapsulating the risk of mortality using PFT and laboratory variables are highly predictive in both females and males, but especially among females. Simple to compute using electronic resources and relatively inexpensive compared to most risk scores, these laboratory-based tools may assist in risk stratification for pulmonary patients undergoing PFT.

CLINICAL IMPLICATIONS: Clinical risk stratification for PFT patients may be enhanced through the use of risk scores utilizing the BMP and CBC laboratory measurements.

DISCLOSURE: Benjamin Horne: Grant monies (from industry related sources): GlaxoSmithKline clinical research support

Matthew Hegewald: Grant monies (from industry related sources): GlaxoSmithKline clinical research support

Joseph Muhlestein: Grant monies (from industry related sources): GlaxoSmithKline clinical research support

Elizabeth Huggins: Grant monies (from industry related sources): GlaxoSmithKline clinical research support

Heidi May: Grant monies (from industry related sources): GlaxoSmithKline clinical research support

Tami Bair: Grant monies (from industry related sources): GlaxoSmithKline clinical research support

Jeffrey Anderson: Grant monies (from industry related sources): GlaxoSmithKline clinical research support

No Product/Research Disclosure Information

Intermountain Heart Institute, Salt Lake City, UT

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