Derivation and validation of a cardiac risk index in liver transplantation

肝移植心脏风险指数的推导和验证

• 批准号: 8398068
• 负责人: Lisa B VanWagner
• 金额: $ 6.22万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8398068
• 关键词: Address; Algorithms; Award; Calibration; Cardiac; Cardiovascular Diseases; Cardiovascular Manifestation; Cardiovascular system; Clinical; Clinical Data; Clinical Management; Clinical Research; Clinical Trials; Comorbidity; Consensus; Data; Data Analyses; Data Sources; Databases; Decision Analysis; Derivation procedure; Development; Diabetes Mellitus; Discrimination; Disease Marker; Evaluation; Event; Evidence Based Medicine; Expert Opinion; Fellowship; Future; Goals; Guidelines; Health Care Costs; Healthcare; Hepatology; Hyperlipidemia; Hypertension; Institutes; Internal Medicine; Investigation; K-Series Research Career Programs; Life; Liver diseases; Medical; Medicine; Mentorship; Methodology; Mission; Modeling; Morbidity - disease rate; Obesity; Operative Surgical Procedures; Organ Donor; Organ Procurements; Organ Transplantation; Outcome; Outcomes Research; Outcomes and Health Services Research; Patients; Performance; Perioperative; Peripheral Resistance; Physiological; Preventive Medicine; Procedures; Process; Public Health; Registries; Relative (related person); Research Project Grants; Resource Allocation; Resources; Risk; Risk Assessment; Risk Factors; Selection Bias; Staging; Statistical Models; Stratification; Transplant Recipients; Transplantation; Universities; Validation; base; cardiovascular disorder epidemiology; cardiovascular disorder risk; cardiovascular risk factor; career development; chronotropic; cost effectiveness; data management; design; high risk; improved; indexing; liver transplantation; meetings; member; mortality; multidisciplinary; patient population; skills; statistics; tool

DESCRIPTION (provided by applicant): The goal of this postdoctoral fellowship is to facilitate the candidate's development as a leader in transplantation outcomes research, with a focus on perioperative cardiovascular (CV) risk assessment. Building on her background in internal medicine, transplant hepatology, and clinical investigation, the candidate proposes to develop additional skills during the award period through (1) coursework designed to expand her methodological skills; (2) interaction with a multidisciplinary team of sponsors and collaborators, including those in cardiovascular epidemiology, risk assessment, transplantation outcomes, and health services research; and (3) a supervised research project. The overall objective of this project is to define and optimize a preoperative cardiovascular risk assessment model for orthotopic liver transplant (OLT) candidates through two primary specific aims: (1) To determine if a national liver transplant-specific Cardiovascular Risk Index (NOLT-CRI) improves the predictive utility of the commonly used revised cardiac risk index (RCRI) by (1.1) determining the discrimination (C-statistic) and calibration (Hosmer-Lemeshow statistic) of the RCRI as a model of 30-day CV events using secondary data analysis of a national database; and (1.2) comparing the clinical performance of the NOLT-CRI to the RCRI in its ability to reclassify 30-day CV risk and to stratify 1- year survival across the continuum of predicted 30-day CV risk; (2) To determine whether additional variables are needed beyond those available within a national database in order to improve the predictive ability of these models by (2.1) determining the model discrimination and calibration of a locally-derived cardiac risk index (LOLT-CRI) using a center-specific database with more detailed clinical data than are currently available nationally; and (2.2) comparing the clinical performance of the LOLT-CRI to the national models in its ability to reclassify risk. This project will meet the mission of the National Institutes of Healthby identifying cardiovascular disease markers that are unique to the liver transplant candidate, which can then be used to improve pre- and post-transplant medical management in this growing patient population. The project, along with the chosen coursework and mentorship, will allow the candidate to become proficient at data management and statistical methodology. Near the end of the award period, the candidate plans to submit a career development award using the results of the project to develop a cardiovascular risk assessment treatment algorithm for use prior to liver transplantation. PUBLIC HEALTH RELEVANCE: Orthotopic liver transplantation (OLT) is a life-saving procedure for patients with end-stage liver disease, but it is not universally available to the public due to a scarcity of donor organs. Cardiovascular disease is an increasing public health problem and is often responsible for severe complications following OLT. This project will benefit public health by assessing the impact of cardiovascular disease on outcomes after OLT and by determining risk predictors for poor outcomes in order to improve the clinical management of OLT recipients in order to maximize the benefit of scarce donor organs.

描述（由申请人提供）：该博士后奖学金的目的是促进候选人作为移植成果研究领导者的发展，重点是围手术期心血管（CV）风险评估。候选人以其内科，移植肝病学和临床调查的背景为基础，建议通过（1）旨在扩大其方法论技能的课程在奖励期内发展额外的技能； （2）与赞助商和合作者的多学科团队互动， 包括心血管流行病学，风险评估，移植成果和卫生服务研究的人； （3）一个有监督的研究项目。 The overall objective of this project is to define and optimize a preoperative cardiovascular risk assessment model for orthotopic liver transplant (OLT) candidates through two primary specific aims: (1) To determine if a national liver transplant-specific Cardiovascular Risk Index (NOLT-CRI) improves the predictive utility of the commonly used revised cardiac risk index (RCRI) by (1.1) determining the discrimination （C统计）和RCRI的校准（Hosmer-Lemeshow统计量），作为30天CV事件的模型，使用国家数据库的二级数据分析； （1.2）将NOLT-CRI与RCRI的临床表现进行比较，以重新分类30天的CV风险并在预测的30天CV风险的连续体中对1年的生存进行重新分类； （2）确定除了（2.1）通过（2.1）确定本地衍生的心脏风险指数（LOLT-CRI）的模型歧视和校准的国家数据库中是否需要其他变量，以提高这些模型的预测能力，并使用中心特异性数据库具有比目前可用的国家更详细的临床数据； （2.2）将LOLT-CRI的临床表现与国家模型进行比较，以重新分类风险。该项目将符合美国国立卫生研究院的使命，该研究所识别肝移植候选者独有的心血管疾病标志物，然后可以用来改善这一不断增长的患者人群中移植前和移植后的医疗管理。该项目以及所选的课程工作和指导将使候选人能够熟练掌握数据管理和统计方法。在奖励期结束时，候选人计划使用该项目的结果提交职业发展奖，以开发一种心血管风险评估治疗算法，以便在肝移植之前使用。 公共卫生相关性：原位肝移植（OLT）是终末期肝病患者的挽救生命程序，但由于供体机器人的稀缺性，公众并未普遍使用。心血管疾病是一个越来越多的公共卫生问题，通常导致OLT之后的严重并发症。该项目将通过评估心血管疾病对OLT后结果的影响，并确定不良结果的风险预测因素，以改善OLT接受者的临床管理，以最大程度地利用稀缺供体器官的好处，从而使公共卫生受益。