Resumen de Evaluation of Mortality Risk with the IMPACT Scale in Patients with Cardiac Transplantation from a Latin American Population

Antonio Figueredo Moreno, Luis Eduardo Echeverría Correa, Víctor Raúl Castillo Mantilla, Adriana Sofía Murcia Tovar, Lyda Zoraya Rojas Sánchez, Edna Magaly Gamboa Delgado

• español

  Objetivo: Evaluar la escala IMPACT para predecir mortalidad hospitalaria y a un año, en pacientes adultos llevados a trasplante cardíaco de la Fundación Cardiovascular de Colombia. Métodos: Estudio de cohorte retrospectiva de 72 pacientes. Se determinó incidencia y tasa de mortalidad durante la hospitalización y al año postrasplante, se compararon curvas de sobrevida, se evaluó la capacidad discriminativa del modelo final y se usaron modelos de riesgos proporcionales de Cox para evaluar los factores asociados a mortalidad. Resultados: La incidencia de mortalidad hospitalaria fue 11.11% (IC 95% 4.92-20.72), y al año 23.61% (IC 95% 14.37-35.09). La sobrevida al año fue 76.39% (IC 95% 64.80-84.60). Pacientes >60 años (HR:2.68 IC 95% 1.54-4.66, p=0.000), con depuración de creatinina <30ml/min (HR:5.07 IC 95% 1.11-23.15, p=0.036) y en diálisis (HR:1.66 IC 95% 1.15-2.40, p=0.006), tuvieron mayor riesgo de mortalidad hospitalaria. Las características asociadas con mortalidad al año fueron: edad >60 años (HR:1.57 IC 95% 1.11-2.23, p=0.011), diálisis (HR:1.62 IC 95% 1.18-2.23, p=0.003), balón de contrapulsación intraaórtico (HR:1.42 IC 95% 1.02-1.98, p=0.040) y dispositivo de asistencia ventricular (HR:1.57 IC 95% 1.03-2.39, p=0.034). El área bajo la curva ROC para mortalidad hospitalaria y a un año postrasplante fue 74.22% (IC 95% 50.67-97.76) y 59.09% (IC 95% 42.20-75.97), respectivamente. Conclusiones: IMPACT tuvo mejor desempeño en la predicción de mortalidad hospitalaria que a un año. Es importante aj

• English

  Background: Given the importance of optimizing organ allocation due to shortage of donors and high costs, it is essential to assess and improve survival rate in patients undergoing heart transplantation. There is currently no specific, integrated and widely accepted tool to assess mortality risk in these patients. Objective: To assess the predictive capacity of the IMPACT scale for in-hospital and one-year mortality in patients undergoing heart transplantation at the Colombian Heart Foundation. Methods: This was a prospective cohort study of 72 patients. Incidences, survival curves, discriminative capacity of the final model, and factors associated with mortality were determined. Results: The incidence of in-hospital and one-year mortality was 11.11% (95% CI 4.92-20.72) and 23.61% (95% CI 14.37-35.09), respectively. Patients >60 years of age (HR 2.68; 95% CI 1.54-4.66; p=0.000), with creatinine clearance <30 ml/min (HR 5.07; 95% CI 1.11-23.15; p=0.036), and dialysis (HR 1.66; 95% CI 1.15-2.40; p=0.006), had higher risk of in-hospital mortality. The characteristics associated with one-year mortality were age >60 years (HR 1.57; 95% CI 1.11-2.23; p=0.011), dialysis (HR 1.62; 95% CI 1.18-2.23; p=0.003), intra-aortic balloon pump counterpulsation (HR 1.42; 95% CI 1.02-1.98; p=0.040) and ventricular assist device (HR 1.57; 95% CI 1.03-2.3; p=0.034). The area under the ROC curve for in-hospital and one-year mortality after transplantation was 74.22% (95% CI 50.67-97.76) and 59.09% (95% CI 42.20-75.97), respectively. Conclusions: IMPACT had better performance in predicting in-hospital than one-year mortality at our institution. It should be cautiously interpreted until variables explaining their regional performance are included.