Advertisement

Exceptional Mortality Prediction by Risk Scores from Common Laboratory Tests

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ringquist I.
        • Fisher L.D.
        • Mock M.
        • et al.
        Prognostic value of angiographic indices of coronary artery disease from the Coronary Artery Surgery Study (CASS).
        J Clin Invest. 1983; 71: 1854-1866
        • Liao L.
        • Kong D.F.
        • Shaw L.K.
        • et al.
        A new anatomic score for prognosis after cardiac catheterization in patients with previous bypass surgery.
        J Am Coll Cardiol. 2005; 46: 1684-1692
        • Zimmerman J.E.
        • Kramer A.A.
        • McNair D.S.
        • Malila F.M.
        Acute physiology and chronic health evaluation (APACHE) IV: hospital mortality assessment for today's critically ill patients.
        Crit Care Med. 2006; 34: 1297-1310
        • Edwards F.H.
        • Grover F.L.
        • Shroyer A.L.W.
        • et al.
        The Society of Thoracic Surgeons national cardiac surgery database: current risk assessment.
        Ann Thorac Surg. 1997; 63: 903-908
        • Rothwell P.M.
        • Giles M.F.
        • Flossmann E.
        • et al.
        A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack.
        Lancet. 2005; 366: 29-36
        • Wilson P.W.F.
        • D'Agostino R.B.
        • Levy D.
        • et al.
        Prediction of coronary heart disease using risk factor categories.
        Circulation. 1998; 97: 1837-1847
        • Anderson J.L.
        • Ronnow B.S.
        • Horne B.D.
        • et al.
        A complete blood count-derived risk score greatly improves cardiovascular predictive ability.
        Am J Cardiol. 2007; 99: 169-174
        • McQuillan G.M.
        • Gunter E.W.
        • Lannom L.
        Field issues for the plan and operation of the laboratory component of the Third National Health and Nutrition Examination Survey.
        J Nutr. 1990; 120: 1446-1450
        • Neaton J.D.
        • Wentworth D.
        • Multiple Risk Factor Intervention Trial Research Group
        Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease.
        Arch Intern Med. 1992; 152: 56-64
        • Shaten B.J.
        • Kuller L.H.
        • Kjelsberg M.O.
        • et al.
        Lung cancer mortality after 16 years in MRFIT participants in intervention and usual-care groups.
        Ann Epidemiol. 1997; 7: 125-136
        • Dankner R.
        • Goldbourt U.
        • Boyko V.
        • Reicher-Reiss H.
        • BIP Study Group
        Predictors of cardiac and noncardiac mortality among 14,697 patients with coronary heart disease.
        Am J Cardiol. 2003; 91: 121-127
        • D'Agostino R.B.
        • Russell M.W.
        • Huse D.M.
        • et al.
        Primary and subsequent coronary risk appraisal: New results from The Framingham Study.
        Am Heart J. 2000; 139: 272-281
        • Felker G.M.
        • Allen L.A.
        • Pocock S.J.
        • et al.
        Red cell distribution width as a novel prognostic marker in heart failure.
        J Am Coll Cardiol. 2007; 50: 40-47
        • Tonelli M.
        • Sacks F.
        • Arnold M.
        • et al.
        Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease.
        Circulation. 2008; 117: 163-168