Abstract
Background
Some components of the complete blood count and basic metabolic profile are commonly
used risk predictors. Many of their components are not commonly used, but they might
contain independent risk information. This study tested the ability of a risk score
combining all components to predict all-cause mortality.
Methods
Patients with baseline complete blood count and basic metabolic profile measurements
were randomly assigned (60%/40%) to independent training (N = 71,921) and test (N
= 47,458) populations. A third population (N = 16,372) from the Third National Health
and Nutrition Examination Survey and a fourth population of patients who underwent
coronary angiography (N = 2558) were used as additional validation groups. Risk scores
were computed in the training population for 30-day, 1-year, and 5-year mortality
using age- and sex-adjusted weights from multivariable modeling of all complete blood
count and basic metabolic profile components.
Results
Area under the curve c-statistics were exceptional in the training population for
death at 30 days (c = 0.90 for women, 0.87 for men), 1 year (c = 0.87, 0.83), and
5-years (c = 0.90, 0.85) and in the test population for death at 30 days (c = 0.88
for women, 0.85 for men), 1 year (c = 0.86, 0.82), and 5 years (c = 0.89, 0.83). In
the test, the Third National Health and Nutrition Examination Survey, and the angiography
populations, risk scores were highly associated with death (P <.001), and thresholds of risk significantly stratified all 3 populations.
Conclusion
In large patient and general populations, risk scores combining complete blood count
and basic metabolic profile components were highly predictive of death. Easily computed
in a clinical laboratory at negligible incremental cost, these risk scores aggregate
baseline risk information from both the popular and the underused components of ubiquitous
laboratory tests.
Keywords
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Article Info
Footnotes
Funding: This study was funded by internal institutional funds.
Conflict of Interest: BDH, HTM, BSR, and JLA are named as inventors on a patent protecting the risk scores; the authors have no other potential conflicts of interest to report.
Authorship: All authors had access to the data and played a role in writing this manuscript.
Trial Registration: Database registry of the Intermountain Heart Collaborative Study: NCT00406185 (ClinicalTrials.gov).
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
