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

基本信息

批准号：
8545595
负责人：
Lisa B VanWagner
金额：
$ 5.94万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-01 至 2014-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8545595
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

项目摘要

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.

描述（由申请人提供）：该博士后奖学金的目标是促进候选人发展成为移植结果研究的领导者，重点是围手术期心血管（CV）风险评估。基于她在内科、移植肝病学和临床研究方面的背景，候选人建议在获奖期间通过以下方式发展额外的技能：(1) 旨在扩展其方法学技能的课程； (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、移植结果和卫生服务研究； (3) 指导研究项目。该项目的总体目标是通过两个主要具体目标来定义和优化原位肝移植（OLT）候选者的术前心血管风险评估模型：（1）确定国家肝移植特异性心血管风险指数（NOLT-CRI） ) 通过 (1.1) 确定 RCRI 的区分度（C 统计量）和校准（Hosmer-Lemeshow 统计量）作为模型，提高了常用的修订心脏风险指数 (RCRI) 的预测效用使用国家数据库的二次数据分析进行 30 天的 CV 事件； (1.2) 比较 NOLT-CRI 与 RCRI 的临床表现，即重新分类 30 天 CV 风险以及在预测的 30 天 CV 风险连续范围内对 1 年生存率进行分层的能力； (2) 确定国家数据库中可用变量之外是否还需要其他变量，以便通过 (2.1) 确定本地衍生心脏风险指数 (LOLT-CRI) 的模型区分和校准来提高这些模型的预测能力使用特定于中心的数据库，该数据库包含比目前全国可用的更详细的临床数据； (2.2) 将 LOLT-CRI 的临床表现与国家模型在重新分类风险的能力方面进行比较。该项目将通过识别肝移植候选者特有的心血管疾病标志物来实现美国国立卫生研究院的使命，然后将其用于改善这一不断增长的患者群体的移植前和移植后医疗管理。该项目以及所选的课程和指导将使候选人能够精通数据管理和统计方法。在奖励期即将结束时，候选人计划利用该项目的结果提交职业发展奖，以开发在肝移植前使用的心血管风险评估治疗算法。

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Evaluating elevated bilirubin levels in asymptomatic adults.

评估无症状成人胆红素水平升高。

DOI：
10.1001/jama.2014.12835
发表时间：
2015
期刊：
JAMA
影响因子：
0
作者：
VanWagner,LisaB;Green,RichardM
通讯作者：
Green,RichardM

Associations between nonalcoholic fatty liver disease and subclinical atherosclerosis in middle-aged adults: the Coronary Artery Risk Development in Young Adults Study.

DOI：
10.1016/j.atherosclerosis.2014.05.962
发表时间：
2014-08
期刊：
ATHEROSCLEROSIS
影响因子：
5.3
作者：
VanWagner, Lisa B.;Ning, Hongyan;Lewis, Cora E.;Shay, Christina M.;Wilkins, John;Carr, J. Jeffrey;Terry, James G.;Lloyd-Jones, Donald M.;Jacobs, David R., Jr.;Carnethon, Mercedes R.
通讯作者：
Carnethon, Mercedes R.

Elevated serum ferritin.

DOI：
10.1001/jama.2014.302
发表时间：
2014-08-20
期刊：
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
影响因子：
120.7
作者：
VanWagner, Lisa B.;Green, Richard M.
通讯作者：
Green, Richard M.

High early cardiovascular mortality after liver transplantation.

DOI：
10.1002/lt.23950
发表时间：
2014-11
期刊：
LIVER TRANSPLANTATION
影响因子：
4.6
作者：
VanWagner, Lisa B.;Lapin, Brittany;Levitsky, Josh;Wilkins, John T.;Abecassis, Michael M.;Skaro, Anton I.;Lloyd-Jones, Donald M.
通讯作者：
Lloyd-Jones, Donald M.

Access to retransplantation after failed donation after circulatory death liver transplantation: eo ire itum.

循环死亡肝移植后捐献失败后获得再移植：eo ire itum。