Intermountain Risk Score Research Articles

Comparative Evaluation of Intermountain Risk Score With Mehran Risk Score for Risk Estimation of Contrast-Induced Nephropathy and Short-Term Mortality in ST-Segment Elevation Myocardial Infarction Patients.

Contrast-induced nephropathy (CIN) has become one of the most important causes of in-hospital acute renal failure with the increasing use of contrast-mediated imaging tools. This significantly increases the morbidity and mortality of the affected subjects and causes a financial burden on the health system. In this context, prediction of CIN is important and some risk scores have been developed to predict CIN. The most frequently used and popular among these is the Mehran Score (MS), which is based on a number of hemodynamic and metabolic parameters. The Intermountain Risk Score (IMRS) is a recently developed risk score that highly predicts short-term mortality based on common laboratory parameters, and many parameters of this risk score have been found to be closely associated with CIN. In this context, we aimed to compare MS and IMRS in terms of CIN and short-term mortality estimation. The study included 931 patients who underwent percutaneous coronary intervention. CIN developed in 21.5% of patients. Both MS and IMRS independently predicted CIN. In receiver operating characteristic analysis, IMRS was found to be non-inferior to MS in predicting CIN and IMRS was superior to MS in predicting short-term mortality. IMRS and MS were independently associated with short-term mortality.

Prognostic role of intermountain risk score (IMRS) in intensive care unit patients with a diagnosis of COVID-19.

In this study, we aimed to assess the predictive value of Intermountain Risk Score (IMRS) in intensive care unit (ICU) patients with COVID-19. Our retrospective study included the data of 194 patients who were admitted to the COVID-19 ICU of a tertiary care center. COVID-19 diagnoses were made by a positive result from a real-time reverse-transcriptase (RT) polymerase chain reaction (PCR) assay of nasal and pharyngeal swab specimens. Patients who had negative RT-PCR results or who were not admitted to ICU and patients under 18 years old were excluded from the study. Complete blood count, biochemistry panel, and blood gas analysis results were gathered and compiled. 194 ICU patients with COVID-19 (PCR positive) were included in the study. The patients were divided into two groups according to IMRS (if IMRS was <15 in women and <17 in men, patients were included in the non-high-risk group, while patients with IMRS ≥15 in women and ≥17 in men were defined as a high-risk group). Multivariate regression analysis was performed to predict in-hospital mortality. The IMRS [OR: 1.17 (1.08-1.27) p<0.001)] was found to predict in-hospital mortality. In this study, we showed that the IMRS score at admission can predict in-hospital mortality in intensive care unit patients with a diagnosis of COVID-19.

Prognostic value of Intermountain Risk Score for short- and long-term mortality in patients with cardiogenic shock.

There is a lack of current research examining the predictive value of the Intermountain Risk Score (IMRS) in patients with ST-segment elevation myocardial infarction (STEMI) caused by cardiogenic shock. Therefore, the purpose of this research was to investigate the ability of IMRS to predict short- and long-term mortality in patients with cardiogenic shock triggered by STEMI. The participants included 492 consecutive cardiogenic shock patients who underwent primary percutaneous coronary intervention following STEMI. The patients were separated into two groups depending on their survival status. The groups' baseline characteristics, laboratory data, echocardiographic variables, and risk assessments were then compared. Next, the IMRS score was tested for its ability to predict both short- and long-term mortality. In order to assess its accuracy, the prognostic value of the IMRS was also compared that of the SYNTAX score II (SSII). After adjustment for the characteristics in the univariable study, multivariable Cox regression analysis indicated that the IMRS and SSII were both independently associated with short- and long-term mortality in STEMI patients with cardiogenic shock. However, the receiver operating characteristic curves indicated that the IMRS outperformed the SSII in terms of predicting both short- and long-term mortality. This preliminary investigation showed that IMRS can predict both short- and long-term mortality in individuals with STEMI accompanied by cardiogenic shock.

Biomarker derived risk scores predict venous thromboembolism and major bleeding among patients with COVID‐19

BackgroundVenous thromboembolism (VTE) risk is increased in patients with COVID‐19 infection. Understanding which patients are likely to develop VTE may inform pharmacologic VTE prophylaxis decision making. The hospital‐associated venous thromboembolism–Intermountain Risk Score (HA‐VTE IMRS) and the hospital‐associated major bleeding–Intermountain Risk Score (HA‐MB IMRS) are risk scores predictive of VTE and bleeding that were derived from only patient age and data found in the complete blood count (CBC) and basic metabolic panel (BMP). ObjectivesWe assessed the HA‐VTE IMRS and HA‐MB IMRS for predictiveness of 90‐day VTE and major bleeding, respectively, among patients diagnosed with COVID‐19, and further investigated if adding D‐dimer improved these predictions. We also reported 30‐day outcomes. Patients/MethodsWe identified 5047 sequential patients with a laboratory confirmed diagnosis of COVID‐19 and a CBC and BMP between 2 days before and 7 days following the diagnosis of COVID‐19 from March 12, 2020, to February 28, 2021. We calculated the HA‐VTE IMRS and the HA‐MB IMRS for all patients. We assessed the added predictiveness of D‐dimer obtained within 48 hours of the COVID test. ResultsThe HA‐VTE IMRS yielded a c‐statistic of 0.70 for predicting 90‐day VTE and adding D‐dimer improved the c‐statistic to 0.764 with the corollary sensitivity/specificity/positive/negative predictive values of 49.4%/75.7%/6.7%/97.7% and 58.8%/76.2%/10.9%/97.4%, respectively. Among hospitalized and ambulatory patients separately, the HA‐VTE IMRS performed similarly. The HA‐MB IMRS predictiveness for 90‐day major bleeding yielded a c‐statistic of 0.64. ConclusionThe HA‐VTE IMRS and HA‐MB IMRS predict 90‐ and 30‐day VTE and major bleeding among COVID‐19 patients. Adding D‐dimer improved the predictiveness of the HA‐VTE IMRS for VTE.

Evaluation of Intermountain Risk Score for Short- and Long-Term Mortality in ST Elevation Myocardial Infarction Patients.

The aim of this study was to examine the Intermountain Risk Score (IMRS) for short- and long-term mortality in ST elevation myocardial infarction (STEMI) patients and compare it with the well-known risk scores, such as the Thrombolysis in Myocardial Infarction (TIMI) and the Global Registry of Acute Coronary Events (GRACE). In this retrospective and cross-sectional study, 1057 consecutive patients with STEMI were evaluated. The end-points of the study were short- and long-term mortality. The overall mortality rate was 16% (n = 170 patients). The IMRS was significantly higher in STEMI patients who did not survive compared with those who survived. According to multivariable COX proportional regression analysis, the IMRS was independently related to both short- (HR: 1.482, 95% CI: 1.325-1.675, p < .001) and long-term mortality (HR: 1.915, 95% CI: 1.711-2.180, p < .001). The comparison of receiver operating characteristic curves revealed that the IMRS had non-inferior predictive capability for short- and long-term mortality than the TIMI and GRACE risk scores. To the best of our knowledge, this is the first study to show that the IMRS can predict short- and long-term prognosis of patients with STEMI. Further, the IMRS' predictive value for overall mortality was non-inferior compared with TIMI and GRACE scores.

Association of the Intermountain Risk Score with major adverse health events in patients positive for COVID-19: an observational evaluation of a US cohort

ObjectivesThe Intermountain Risk Score (IMRS), composed using published sex-specific weightings of parameters in the complete blood count (CBC) and basic metabolic profile (BMP), is a validated predictor of mortality. We...

Association between Intermountain Risk Score and long-term mortality with the transcatheter aortic valve implantation procedure.

Since its first introduction, the spectrum and frequency of use of transcatheter aortic valve implantation (TAVI) have increased throughout the world. Therefore, it is crucial to determine which patients are at high mortality risk with TAVI. The Intermountain Risk Score (IMRS) is a score calculated from laboratory parameters. This study aimed to determine the long-term mortality of TAVI patients using the IMRS and to compare it with traditional scoring systems. The study included a total of 133 patients undergoing TAVI at our hospital from 2010 to 2019. Demographic data, co-morbid diseases, echocardiographic and laboratory parameters were collected retrospectively. The performance of IMRS was assessed as compared to the mortality determined in the overall patient population. During the follow-up, 54.9% of patients (60 patients) (Group 1) survived; the mortality in Group 2 (60 patients) was 45.1%. The survival period had a mean of 1433 (±124) days. The mean IMRS was 1.67 (0.7) in Group 1 and 2.33 (0.72) in Group 2 (P <0.001). In multivariable analyses, only high risk of IMRS (hazard ratio [HR], 3.430; 95% confidence interval [CI], 1.537-7.653; P = 0.003) and EuroSCORE II (HR, 1.141; 95% CI, 1.011-1.288; P = 0.03) independently predicted long-term mortality. From the evaluation of all laboratory and echocardiography parameters, long-term mortality (>30 days) following the TAVI procedure can be said to be higher in patients with a high IMRS. The data from this study can be considered of value in demonstrating the clinical significance of IMRS calculation before the TAVI procedure.

Validation of the Intermountain Risk Score and Get with the Guidelines—Heart Failure Score in predicting mortality

ObjectiveThe Intermountain Risk Score (IMRS) was evaluated for validation as a mortality predictor and compared with the American Heart Association’s Get With The Guidelines—Heart Failure (GWTG-HF) risk score in a...

Post‐discharge thrombosis and bleeding in medical patients: A novel risk score derived from ubiquitous biomarkers

BackgroundSome hospitalized medical patients experience venous thromboembolism (VTE) following discharge. Prophylaxis extended beyond hospital discharge (extended duration thromboprophylaxis [EDT]) may reduce this risk. However, EDT is costly and can cause bleeding, so selecting appropriate patients is essential. We formerly reported the performance of a mortality risk prediction score (Intermountain Risk Score [IMRS]) that was minimally predictive of 90‐day hospital‐associated venous thromboembolism (HA‐VTE) and major bleeding (HA‐MB). We used the components of the IMRS to calculate de novo risk scores to predict 90‐day HA‐VTE (HA‐VTE IMRS) and major bleeding (HA‐MB IMRS). MethodsFrom 45 669 medical patients we randomly assigned 30 445 to derive the HA‐VTE IMRS and the HA‐MB IMRS. Backward stepwise regression and bootstrapping identified predictor covariates from the blood count and basic chemistry. These candidate variables were split into quintiles, and the referent quintile was that with the lowest event rate for HA‐VTE and HA‐MB; respectively. A clinically relevant rate of HA‐VTE and HA‐MB was used to inform outcome rates. Performance was assessed in the derivation set of 15 224 patients. ResultsThe HA‐VTE IMRS and HA‐MB IMRS area under the receiver operating curve (AUC) in the derivation set were 0.646, and 0.691, respectively. In the validation set, the HA‐VTE IMRS and HA‐MB IMRS AUCs were 0.60 and 0.643. ConclusionsRisk scores derived from components of routine labs ubiquitous in clinical care identify patients that are at risk for 90‐day postdischarge HA‐VTE and major bleeding. This may identify a subset of patients with high HA‐VTE risk and low HA‐MB risk who may benefit from EDT.

A Prognostic Tool for COVID-19 Decision Support: The Intermountain Risk Score Predicts Major Adverse Health Events in Patients Positive for COVID-19

Background: As the COVID-19 pandemic evolves, stratifying risk is increasingly important. The Intermountain Risk Score (IMRS) uses the complete blood count (CBC) and basic metabolic profile (BMP) as a first-line predictor of mortality and is widely validated. We hypothesized that IMRS predicts COVID-19 outcomes.Methods: Intermountain Healthcare patients aged ≥18 years were evaluated if they had CBC and BMP measured in 2019 and tested positive for COVID-19 in 2020. Viral RNA testing for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was conducted March 3 through November 2, 2020. IMRS used published sex-specific weightings and associations were evaluated for the composite of COVID-19 hospitalization or mortality.Findings: Among 3,883 patients, 8.2% were hospitalized, 1.6% died. Subjects with low, mild, moderate, and high-risk IMRS had the composite endpoint in 3.5% (52/1,502), 8.6% (108/1,256), 15.5% (152/979), and 28.1% (41/146), respectively. Versus low-risk, subjects in mild, moderate, and high-risk groups had HR=2.33 (95% CI: 1.67, 3.24), HR=4.01 (CI: 2.93, 5.50), and HR=8.34 (CI: 5.54, 12.57), respectively. Subjects aged Interpretation: IMRS, a simple risk score using very basic laboratory results, predicted COVID-19 hospitalization and mortality. This included important abilities to identify risk in younger adults with few diagnosed comorbidities and to predict risk prior to SARS-CoV-2 infection.Funding Statement: This study was funded by internal Intermountain departmental funds.Declaration of Interests: BDH, HTM, BSR, and JLA are inventors of clinical decision tools that are licensed to CareCentra and Alluceo. BDH is the PI of grants related to clinical decision tools that were funded by Intermountain Healthcare’s Foundry innovation program, the Intermountain Research and Medical Foundation, CareCentra, GlaxoSmithKline, and AstraZeneca. BDH is a member of the scientific advisory board of Labme.ai. KUK is PI of and BDH a co-investigator of a grant funded by the Patient- Centered Outcomes Research Institute (PCORI). IDP was supported by a grant from the National Institute of General Medical Sciences (K23GM129661). Outside the current work, IDP has received grant support from the National Institutes of Health, Centers for Disease Control, Janssen Pharmaceuticals, and Immunexpress Inc and funding to his institution from Regeneron Pharmaceuticals. The authors have no other potential conflicts of interest to report.Ethics Approval Statement: This study was approved as a data-only historical records review study with a waiver of consent by the Intermountain Healthcare Institutional Review Board.

Validation of the Summit Lab Score in Predicting Exacerbations of Chronic Obstructive Pulmonary Disease Among Individuals with High Arterial Stiffness.

IntroductionThe presence of cardiovascular (CV) risk factors and CV disease in patients with chronic obstructive pulmonary disease (COPD) leads to worse outcomes. A number of tools are currently available to stratify the risk of adverse outcomes in these patients with COPD. This post hoc analysis evaluated the Summit Lab Score for validation as a predictor of the first episode of moderate-to-severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and other outcomes, in patients with COPD and high arterial pulse wave velocity (aPWV).MethodsData from a multicenter, randomized, placebo-controlled, double-blind study were retrospectively analyzed to evaluate treatment effects of once-daily fluticasone furoate/vilanterol 100/25 μg in patients with COPD and an elevated CV risk (aPWV≥11m/s) over 24 weeks. The previously derived Summit Lab Score and, secondarily, the Intermountain Risk Score (IMRS) were computed for each patient, with patients then stratified into tertiles for each score. Risk of moderate-to-severe AECOPD was analyzed across tertiles using Kaplan–Meier survival curve and Cox regression analyses.ResultsIn 430 patients with COPD, Kaplan–Meier probabilities of no moderate-to-severe AECOPD for Summit Lab Score tertiles 1, 2, and 3 were 92.3%, 95.5%, and 85.1%, respectively (P trend = 0.015), over 24 weeks. Grouped by IMRS tertiles, the respective probabilities were 92.9%, 91.2%, and 88.3%, respectively (P trend = 0.141). Length of stay in the hospital (P = 0.034) and the hospital ward (P = 0.042) were also significantly different between Summit Lab Score tertiles but not for intensive care (P = 0.191).ConclusionThe Summit Lab Score was associated with the 24-week risk of moderate-to-severe AECOPD in COPD patients with elevated CV risk. Secondarily, IMRS showed a trend towards differences in the risk of AECOPD, which was not statistically significant.

Abstract 14486: Validation of the Intermountain Risk Score and Get With the Guidelines-Heart Failure Score in Predicting 30 Day and 1 Year Mortality

Background: The Intermountain Risk Score (IMRS) predicts mortality in heart failure (HF) patients utilizing common, inexpensive tests in conjunction with patient age and sex. IMRS has not been validated for Essentia Health (EH)’s patient population nor compared to various pre-existing scores in this population. Methods: Individuals were selected from the American Heart Association’s Get With The Guidelines®- HF (GWTG-HF) registry as patients to evaluate in a retrospective study. This patient population consists of consecutive inpatients age ≥18 admitted with a HF diagnosis at EH from 7/2017 through 6/2019. IMRS was derived using common HF laboratory measures (complete blood count and basic metabolic profile), age, and sex. EH is a large rural health care system in MN, WI, and ND. Results: A total of 703 individuals (mean age: 74.20, 44.38% female) were studied. The 30-day IMRS predicted 30 day mortality for both sexes (Females N=312: OR=1.19 (95% confidence interval: 1.08, 1.32) per +1, p&lt;0.001; Males N=391: OR=1.23 (1.12, 1.36) per +1, p&lt;0.001). The 1-year IMRS predicted 1-year mortality (Females: OR=1.14 (1.06, 1.23) per +1, p&lt;0.001; Males: OR=1.28 (1.18, 1.38) per +1, p&lt;0.001). Using sex-specific cut offs for IMRS, females had better 30-day risk stratification in moderate to high risk groups compared to low risk reference group (Mod-risk: OR=5.90 (1.35, 25.85), p=0.018; high-risk: OR=9.63 (2.12, 43.72), p=0.003) vs. men (Mod-risk: OR=1.52 (0.61, 3.79), p=0.37; high risk: OR=4.53 (1.92, 10.65), p&lt;0.001). The GWTG-HF risk score was significant for 30-day (OR=1.29 (1.16, 1.44) per +1, p&lt;0.001) and 1-year mortality (OR=1.23 (1.13, 1.35) per +1, p&lt;0.001) but was only calculated in 292 patients (41.5%). Conclusions: The Intermountain Risk Score is a useful predictor of 30-day and 1-year mortality for heart failure patients in a large rural healthcare system. The GWTG-HF risk score also predicts 30-day and 1-year mortality but is often not calculated due to not all variables being collected at each hospital visit (i.e. ejection fraction). The IMRS risk score uses simple variables that most patients have on admission and future study to evaluate cost-effectiveness as a prospective tool for initial risk estimation is warranted.

Abstract 16681: Ability of the Intermountain Risk Score Measured in 2019 (pre-COVID) to Predict Major Adverse Health Events in Patients Positive for SARS-CoV-2 in 2020

Background: The Intermountain Risk Sore (IMRS) is a general health clinical decision tool based on the complete blood count (CBC) and basic metabolic profile (BMP). IMRS was developed to predict all-cause mortality. IMRS was validated previously in patients from the US and elsewhere, including in general medical and surgical patients and in diagnosis-specific populations. IMRS has been implemented at Intermountain Healthcare to guide clinical care in hospital settings. IMRS has not been tested as a predictor of major adverse health events after diagnosis of novel coronavirus disease (COVID)-19. Methods: Intermountain patients (ages ≥18 years) with a CBC and BMP measured in 2019 and with a COVID-positive test in 2020 (N=1,025) were evaluated to determine if the pre-2020 IMRS predicted a composite of hospitalization or mortality. All study subjects tested positive for COVID between March 3 and June 8, 2020. IMRS was calculated using original sex-specific variable weightings (see Horne BD et al, Am J Med 2009). Results: Overall, 55 females and 54 males had a composite endpoint, respectively (5 and 10 deaths; 52 and 46 hospitalizations), with c-statistics of c=0.748 for females and c=0.669 for males using IMRS calculations from 2019 (see Table). For n=170 patients, IMRS was also calculated from 2020 CBC/BMP panels obtained at the time of COVID diagnosis, and it also predicted the composite endpoint at that timepoint (for females and males combined, odds ratios= 4.05, 2.46, and 1.53 for high-, moderate-, and mild-risk categories vs. low-risk; see Table for category thresholds). Conclusion: IMRS measured using 2019 CBC and BMP lab results predicted major adverse health events for patients diagnosed with COVID in 2020. Use of IMRS may empower population health with anticipation of COVID outcomes; for higher risk patients, the IMRS result may lead to enhanced preventive measures if the patient is free of COVID and, if COVID is diagnosed, it may lead to earlier, more aggressive care.

DERIVATION AND VALIDATION OF THE HA-VTE AND HA-MB INTERMOUNTAIN RISK SCORES FROM UBIQUITOUS CLINICAL BIOMARKERS TO PREDICT 90-DAY HOSPITAL-ASSOCIATED VENOUS THROMBOEMBOLISM AND MAJOR BLEEDING AMONG MEDICAL PATIENTS

SESSION TITLE: Late-breaking Abstracts SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Identify hospitalized medical patients who at discharge have significant risk for hospital-associated venous thromboembolism (HA-VTE) or major bleeding (HA-MB) to inform extended-duration thromboprophylaxis (EDT) decision-making. METHODS: The Intermountain risk score (IMRS) is a highly predictive mortality risk estimation tool derived from components of the complete blood count (CBC) and basic metabolic panel (BMP). While minimally predictive for the outcome of 90-day HA-VTE [Snyder,L 2020] we hypothesized that IMRS components from the CBC and BMP could be re-weighted to be more predictive of HA-VTE and major bleeding (“HA-VTE IMRS” & “HA-MB IMRS”). To do so, a dataset of 45,669 medical patients who survived hospitalization in which 1038 (1.6%) VTE and 611 (1.3%) major bleeding events were recorded (as determined using validated natural language processing in EMR interrogation [Evans,RS 2010]) was split into a derivation (2/3) and validation (1/3) cohort. In the derivation set the CBC and BMP candidate variables were split into quintiles, and the referent quintile was determined as that with the lowest event rate. Backward stepwise regression in 500 bootstrapped samples was performed to identify predictors from the BMP and CBC candidate variables. A Cox model was fit in the derivation dataset with the variables included in 80%, 70%, 60%, and 50% of bootstrapped samples; these models were compared using likelihood ratio tests to determine if the additional variables included at each threshold significantly improved model fit. Coefficients from the Cox model were used to assign weights for the quintiles to generate the HA-VTE IMRS and HA-MB IMRS cutoff thresholds. Covariates selected for the final VTE model were: RDW, BUN, age, glucose, WBC, platelet count, RBC and sodium. Covariates selected for the final major bleeding model were: RDW, age, creatinine, MPV, Sodium, and RBC. RESULTS: In the derivation set 563/30,445 patients experienced HA-VTE and 399/30,445 experienced HA-MB. The HA-VTE IMRS ≥ 7 generated an AUC=0.603 and the HA-MB IMRS ≥ 8 generated an AUC=0.624. In the validation set 137/5242 had VTE in the HA-VTE IMRS ≥ 7 cohort vs. 160/9982 with a HA-VTE IMRS < 7 (2.6% vs 1.6%; HR=1.69; 95% CI 1.35-2.13; AUC=0.60). 135/7101 had MB in the HA-MB IMRS ≥ 8 cohort vs. 67/8123 with a HA-MB IMRS < 8 (1.9% vs. 0.8%; HR=2.35; 95% CI 1.75-3.16; AUC=0.64). CONCLUSIONS: HA-VTE and HA-MB risk may be estimated electronically at the time of hospital discharge based on components of the CBC and BMP. This information may inform decision-making regarding the prescription of EDT. CLINICAL IMPLICATIONS: If validated, this electronic program may be deployed in an EMR to calculate 90-day HA-VTE risk at the time of discharge with no additional time or expense based on laboratory values that are ubiquitously available and could inform decision-making regarding extended duration thromboprophylaxis for medical patients. DISCLOSURES: Consultant relationship with BD Please note: $5001 - $20000 Added 07/17/2020 by Joseph Bledsoe, source=Web Response, value=Consulting fee No relevant relationships by masarret fazili, source=Web Response PI of research grant relationship with AstraZeneca Please note: $20001 - $100000 Added 07/17/2020 by Benjamin Horne, source=Web Response, value=Grant/Research Support PI of research grant relationship with GlaxoSmithKline Please note: $1-$1000 Added 07/17/2020 by Benjamin Horne, source=Web Response, value=Grant/Research Support PI of research grant relationship with CareCentra Please note: $1-$1000 Added 07/17/2020 by Benjamin Horne, source=Web Response, value=Grant/Research Support Owner of intellectual property relationship with Alluceo Please note: $1-$1000 Added 07/17/2020 by Benjamin Horne, source=Web Response, value=IP was licensed Owner of intellectual property relationship with CareCentra Please note: $1-$1000 Added 07/17/2020 by Benjamin Horne, source=Web Response, value=IP was licensed No relevant relationships by James Lloyd, source=Web Response No relevant relationships by Gregory Snow, source=Web Response Research contract (no longer active) relationship with BMS/Pfizer Please note: $1-$1000 Added 07/17/2020 by Scott Stevens, source=Web Response, value=Grant/Research Support No relevant relationships by Scott Woller, source=Web Response

Abstract 271: Mitochondrial DNA Copy Number in Peripheral Blood Cells is Associated With All -Cause Mortality in Older Cardiovascular Patients

Background: Mitochondrial DNA copy number (Mt CN) is a surrogate marker of mitochondrial function. Variations in Mt CN have been associated with several age-related diseases. Lower Mt CN may indicate impaired cellular energy production whereas higher Mt CN may compensate for energy disbalance but also may lead to cellular damage through oxidative stress. This study evaluated the association of Mt CN and all-cause mortality in older cardiovascular patients (Pt). Methods: The study was approved by the Intermountain Healthcare Institutional Review Board. Consenting subjects (n=2,253) were participants in the INSPIRE registry undergoing cardiac catheterization at the Intermountain Heart Institute. Total DNA was extracted from EDTA stabilized blood with either Puregene (Qiagen) or Reliaprep (Promega) reagents. Relative Mt CN measurements were performed with multiplexed real-time polymerase chain reaction coamplifying a stable site of Mt D- Loop and a region of a single copy nuclear β-2-microglobulin gene(β2M) and calculated as a ratio of Mt to β2M DNA. Cox regression was used to evaluate the association of Mt CN with all-cause mortality, with adjustment considering 32 covariables. Further adjustment entered the Intermountain Risk Score (IMRS), a validated mortality risk predictor. Results: Mean Pt age was age 62.3±13.8 yrs.; 65.2% were male; 1,122 (50%) died during 25.4 years of follow-up. Mt CN was lower for males (539±449 vs 654 ± 1053 for females; p=0.004). Mt CN was 616±917 in decedents and 542±438 in survivors (p=0.014). In univariable Cox regression, Quartile 1 versus Quartile 4 of Mt CN was associated with the highest mortality risk (hazard ratio [HR]=1.45, CI=1.22, 1.71, p&lt;0.001). This association remained significant after multivariable adjustment (HR=1.30, CI=1.10, 1.54, p=0.003). There was minimal correlation between IMRS and Mt CN continuous values (r= -0.09 for males, r= -0.13 for females). In Cox regression, adjustment for IMRS and covariables showed Mt CN remained associated with mortality (HR=1.30, CI=1.08, 1.57, p=0.006). Conclusions: Low Mt CN is independently associated with higher risk of all-cause mortality. Further studies validating this finding and examining potential underlying physiologic protective mechanisms may prove to be of therapeutic and prognostic value.

Predicting postdischarge hospital‐associated venous thromboembolism among medical patients using a validated mortality risk score derived from common biomarkers

BackgroundDischarged medical patients are at risk for venous thromboembolism (VTE). It is difficult to identify which discharged patients would benefit from extended duration thromboprophylaxis. The Intermountain Risk Score is a prediction score derived from discrete components of the complete blood cell count and basic metabolic panel and is highly predictive of 1‐year mortality. We sought to ascertain if the Intermountain Risk Score might also be predictive of 90‐day postdischarge hospital‐associated VTE (HA‐VTE). MethodsWe applied the Intermountain Risk Score to 60 064 medical patients who survived 90 days after discharge and report predictiveness for HA‐VTE. Area under the receiver operating curve analyses were performed. We then assessed whether the Intermountain Risk Score improved prediction of 2 existing VTE risk assessment models. ResultsThe Intermountain Risk Score poorly predicted HA‐VTE (area under the curve = 0.58; 95% confidence interval [CI], 0.56‐0.60). Each clinical risk assessment model was superior to the Intermountain Risk Score (UTAH area under the curve, 0.63; Kucher area under the curve, 0.62; Intermountain Risk Score area under the curve, 0.58; P < .001 for each comparison). Adding the Intermountain Risk Score to these scores did not substantially improve the performance of either risk assessment model (UTAH + Intermountain Risk Score, 0.65; Kucher + Intermountain Risk Score, 0.64). ConclusionThe Intermountain Risk Score demonstrated poor predictiveness for HA‐VTE when compared to existing risk assessment models. Adding the Intermountain Risk Score to existing risk assessment models did not improve upon either risk assessment model alone to justify the added complexity.

Comparative evaluation of the clinical laboratory-based Intermountain risk score with the Charlson and Elixhauser comorbidity indices for mortality prediction

BackgroundThe Charlson and Elixhauser comorbidity indices are mortality predictors often used in clinical, administrative, and research applications. The Intermountain Mortality Risk Scores (IMRS) are validated mortality predictors that use all factors from the complete blood count and basic metabolic profile. How IMRS, Charlson, and Elixhauser relate to each other is unknown.MethodsAll inpatient admissions except obstetric patients at Intermountain Healthcare’s 21 adult care hospitals from 2010–2014 (N = 197,680) were examined in a observational cohort study. The most recent admission was a patient’s index encounter. Follow-up to 2018 used hospital death records, Utah death certificates, and the Social Security death master file. Three Charlson versions, 8 Elixhauser versions, and 3 IMRS formulations were evaluated in Cox regression and the one of each that was most predictive was used in dual risk score mortality analyses (in-hospital, 30-day, 1-year, and 5-year mortality).ResultsIndices with the strongest mortality associations and selected for dual score study were the age-adjusted Charlson, the van Walraven version of the acute Elixhauser, and the 1-year IMRS. For in-hospital mortality, Charlson (c = 0.719; HR = 4.75, 95% CI = 4.45, 5.07), Elixhauser (c = 0.783; HR = 5.79, CI = 5.41, 6.19), and IMRS (c = 0.821; HR = 17.95, CI = 15.90, 20.26) were significant predictors (p<0.001) in univariate analyses. Dual score analysis of Charlson (HR = 1.79, CI = 1.66, 1.92) with IMRS (HR = 13.10, CI = 11.53, 14.87) and of Elixhauser (HR = 3.00, CI = 2.80, 3.21) with IMRS (HR = 11.42, CI = 10.09, 12.92) found significance for both scores in each model. Results were similar for 30-day, 1-year, and 5-year mortality.ConclusionsIMRS provided the strongest ability to predict mortality, adding to and attenuating the predictive ability of the Charlson and Elixhauser indices whose mortality associations remained statistically significant. IMRS uses common, standardized, objective laboratory data and should be further evaluated for integration into mortality risk evaluations.

Improving risk stratification in heart failure with preserved ejection fraction by combining two validated risk scores

IntroductionThe Intermountain Risk Score (IMRS) was developed and validated to predict short-term and long-term mortality in hospitalised patients using demographics and commonly available laboratory data. In this study, we sought...

Evaluation of “intermountain mortality risk score” (IMRS) as an outcome predictor in medico-legal trauma cases admitted to Ain Shams specialized hospital

Evaluation of “intermountain mortality risk score” (IMRS) as an outcome predictor in medico-legal trauma cases admitted to Ain Shams specialized hospital

Abstract 12709: Addition of Depression Severity Indices to the Intermountain Risk Score for Predicting 3-Year Risk of Chronic Disease: The Mental Health Integration Risk Score

Introduction: Depression (DPN) is a common illness that imposes a disproportionately large health burden. DPN is generally associated with higher prevalence of chronic disease (ChrD) risk factors and may contribute higher ChrD risk. Previously, the Intermountain Mortality Risk Score (IMRS) was shown to predict DPN incidence and post-diagnosis outcomes. Hypothesis: Sex-specific Mental Health Integration risk scores (MHIRS) can be developed based on the principles underlying IMRS and adding DPN severity indices to predict 3 year ChrD diagnosis. Methods: MHIRS was created to predict the first diagnosis of any of 10 ChrD (diabetes, renal failure, CAD, MI, HF, PVD, AF, stroke, dementia, or COPD) in patients completing a PHQ-9 DPN survey and were free at baseline from those 10 ChrD diagnoses. MHIRS used sex-specific weightings of PHQ-9 results, age, and components of the comprehensive metabolic panel and complete blood count in randomly-chosen derivation (70%) and validation (30%) groups. Results: Females (N=10,162; age: 48±16) and males (N=4615, age: 48±15) were studied. Among females, c-statistics for the composite ChrD endpoint were 0.746 (0.725, 0.767) for the derivation group and 0.717 (0.682, 0.753) for the validation group, while males had 0.755 (0.727, 0.783) and 0.742 (0.702, 0.782). See Table for MHIRS prediction of each ChrD. In the validation group, MHIRS strata of low, moderate, and high risk had hazard ratios (HR) for any 3-year ChrD diagnosis among females of HR=3.42 for moderate vs. low and HR=9.75 for high vs low, while males had HR=4.80 and HR=10.68, respectively (all p&lt;0.0001). Conclusion: A clinical decision tool composed of DPN severity and common lab tests, MHIRS provided very good discrimination of a 3 year ChrD diagnosis. Designed to be calculated electronically by an electronic health record, MHIRS can be efficiently obtained by clinicians to identify patients at higher ChrD risk who require further evaluation and more precise clinical management.