Background Based on the China-VHD database,this study sought to develop and validate a Valvular Heart Disease-specific Age-adjusted Comorbidity Index(VHD-ACI)for predicting mortality risk in patients with VHD.Methods&...Background Based on the China-VHD database,this study sought to develop and validate a Valvular Heart Disease-specific Age-adjusted Comorbidity Index(VHD-ACI)for predicting mortality risk in patients with VHD.Methods&Results The China-VHD study was a nationwide,multi-centre multi-centre cohort study enrolling 13,917 patients with moderate or severe VHD across 46 medical centres in China between April-June 2018.After excluding cases with missing key variables,11,459 patients were retained for final analysis.The primary endpoint was 2-year all-cause mortality,with 941 deaths(10.0%)observed during follow-up.The VHD-ACI was derived after identifying 13 independent mortality predictors:cardiomyopathy,myocardial infarction,chronic obstructive pulmonary disease,pulmonary artery hypertension,low body weight,anaemia,hypoalbuminaemia,renal insufficiency,moderate/severe hepatic dysfunction,heart failure,cancer,NYHA functional class and age.The index exhibited good discrimination(AUC,0.79)and calibration(Brier score,0.062)in the total cohort,outperforming both EuroSCORE II and ACCI(P<0.001 for comparison).Internal validation through 100 bootstrap iterations yielded a C statistic of 0.694(95%CI:0.665−0.723)for 2-year mortality prediction.VHD-ACI scores,as a continuous variable(VHD-ACI score:adjusted HR(95%CI):1.263(1.245-1.282),P<0.001)or categorized using thresholds determined by the Yoden index(VHDACI≥9 vs.<9,adjusted HR(95%CI):6.216(5.378-7.184),P<0.001),were independently associated with mortality.The prognostic performance remained consistent across all VHD subtypes(aortic stenosis,aortic regurgitation,mitral stenosis,mitral regurgitation,tricuspid valve disease,mixed aortic/mitral valve disease and multiple VHD),and clinical subgroups stratified by therapeutic strategy,LVEF status(preserved vs.reduced),disease severity and etiology.Conclusion The VHD-ACI is a simple 13-comorbidity algorithm for the prediction of mortality in VHD patients and providing a simple and rapid tool for risk stratification.展开更多
基金supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(No.2017-12M-3-002)the National Key R&D Program of China(No.2020YFC2008100).
文摘Background Based on the China-VHD database,this study sought to develop and validate a Valvular Heart Disease-specific Age-adjusted Comorbidity Index(VHD-ACI)for predicting mortality risk in patients with VHD.Methods&Results The China-VHD study was a nationwide,multi-centre multi-centre cohort study enrolling 13,917 patients with moderate or severe VHD across 46 medical centres in China between April-June 2018.After excluding cases with missing key variables,11,459 patients were retained for final analysis.The primary endpoint was 2-year all-cause mortality,with 941 deaths(10.0%)observed during follow-up.The VHD-ACI was derived after identifying 13 independent mortality predictors:cardiomyopathy,myocardial infarction,chronic obstructive pulmonary disease,pulmonary artery hypertension,low body weight,anaemia,hypoalbuminaemia,renal insufficiency,moderate/severe hepatic dysfunction,heart failure,cancer,NYHA functional class and age.The index exhibited good discrimination(AUC,0.79)and calibration(Brier score,0.062)in the total cohort,outperforming both EuroSCORE II and ACCI(P<0.001 for comparison).Internal validation through 100 bootstrap iterations yielded a C statistic of 0.694(95%CI:0.665−0.723)for 2-year mortality prediction.VHD-ACI scores,as a continuous variable(VHD-ACI score:adjusted HR(95%CI):1.263(1.245-1.282),P<0.001)or categorized using thresholds determined by the Yoden index(VHDACI≥9 vs.<9,adjusted HR(95%CI):6.216(5.378-7.184),P<0.001),were independently associated with mortality.The prognostic performance remained consistent across all VHD subtypes(aortic stenosis,aortic regurgitation,mitral stenosis,mitral regurgitation,tricuspid valve disease,mixed aortic/mitral valve disease and multiple VHD),and clinical subgroups stratified by therapeutic strategy,LVEF status(preserved vs.reduced),disease severity and etiology.Conclusion The VHD-ACI is a simple 13-comorbidity algorithm for the prediction of mortality in VHD patients and providing a simple and rapid tool for risk stratification.
