Home Improvement in the predictive ability of the Intermountain Mortality Risk Score by adding routinely collected laboratory tests such as albumin, bilirubin, and white cell differential count
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Improvement in the predictive ability of the Intermountain Mortality Risk Score by adding routinely collected laboratory tests such as albumin, bilirubin, and white cell differential count

  • Heidi T. May EMAIL logo , Jeffrey L. Anderson , Joseph B. Muhlestein , Donald L. Lappé , Brianna S. Ronnow and Benjamin D. Horne
Published/Copyright: April 21, 2016
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 54 Issue 10

Abstract

Background:

The Intermountain Mortality Risk Score (IMRS), a sex-specific mortality-prediction metric, has proven to be effective in various populations. IMRS is comprised of the complete blood count (CBC), basic metabolic panel (BMP), and age. Whether the addition of factors from the comprehensive metabolic panel (CMP) and white blood cell (WBC) differential count improves risk stratification is unknown.

Methods:

Patients with baseline complete metabolic panel (CMP) and IMRS measurements were randomly assigned (60%/40%) to independent derivation (n=84,913) and validation (n=56,584) populations. A sex-specific risk score based on IMRS methods was computed in the derivation population using adjusted multivariable regression weights from all significant and noncollinear CMP [expanded IMRS (eIMRS)] and, when available, WBC differential components (eIMRS+diff).

Results:

Age averaged 67±16 years for females and 67±15 years for males. Receiver operator characteristic (ROC) c-statistics for 30-day death showed marked improvement for the eIMRS compared to the IMRS in both females [0.895 (0.882, 0.908) vs. 0.865 (0.850, 0.880)] and males [0.861 (0.847, 0.876) vs. 0.824 (0.807, 0.841)]. These results persisted for 1-year death: females [0.854 (0.847, 0.862) vs. 0.828 (0.819, 0.836)] and males [0.835 (0.826, 0.844) vs. 0.796 (0.789, 0.808)]. In addition, the eIMRS significantly improved risk reclassification. Further precision was seen when WBC differential components were included.

Conclusions:

The addition of the CMP components to the IMRS improved risk prediction. WBC differential also improved risk score predictive ability. These results suggest that the eIMRS may function even better than IMRS as a tool in patient care, risk-adjustment, and clinical research settings for predicting outcomes.

Keywords: comprehensive metabolic panel; Intermountain Risk Score (IMRS); laboratory tests; risk scores; white blood cell differential

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: Ms. Ronnow and Drs. May, Horne, and Anderson have a risk score licensing contract for the Intermountain Risk Score with Scriplogix, Inc.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Supplemental Material:

The online version of this article (DOI: 10.1515/cclm-2015-1258) offers supplementary material, available to authorized users.

Received: 2015-12-21
Accepted: 2016-3-8
Published Online: 2016-4-21
Published in Print: 2016-10-1

©2016 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2015-1258
Keywords for this article
comprehensive metabolic panel; Intermountain Risk Score (IMRS); laboratory tests; risk scores; white blood cell differential

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Serum myoglobin immunoassays: obsolete or still clinically useful?
  4. Reviews
  5. Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management
  6. What do we know about homocysteine and exercise? A review from the literature
  7. Mini Review
  8. Osteocalcin as a potential risk biomarker for cardiovascular and metabolic diseases
  9. Opinion Paper
  10. Statistical approach for optimization of external quality assurance (EQA) studies of molecular and serological viral diagnostics
  11. EFLM Article
  12. Sample collections from healthy volunteers for biological variation estimates’ update: a new project undertaken by the Working Group on Biological Variation established by the European Federation of Clinical Chemistry and Laboratory Medicine
  13. General Clinical Chemistry and Laboratory Medicine
  14. Analyte stability during the total testing process: studies of vitamins A, D and E by LC-MS/MS
  15. Improvement in the predictive ability of the Intermountain Mortality Risk Score by adding routinely collected laboratory tests such as albumin, bilirubin, and white cell differential count
  16. Cystatin C provides a better estimate of the effect of glomerular filtration rate on serum human epididymis protein 4 concentrations
  17. Verification of the harmonization of human epididymis protein 4 assays
  18. Clinical utility of urinary liver-type fatty acid binding protein measured by latex-enhanced turbidimetric immunoassay in chronic kidney disease
  19. Comparison of three analytical platforms for quantification of the neurofilament light chain in blood samples: ELISA, electrochemiluminescence immunoassay and Simoa
  20. Reference Values and Biological Variations
  21. Distribution of antiphospholipid antibodies in a large population-based German cohort
  22. Cardiovascular Diseases
  23. Serum protein S100 as marker of postoperative delirium after off-pump coronary artery bypass surgery: secondary analysis of two prospective randomized controlled trials
  24. Infectious Diseases
  25. Copeptin predicts 10-year all-cause mortality in community patients: a 10-year prospective cohort study
  26. Clinical and laboratory findings in the diagnosis of right lower quadrant abdominal pain: outcome analysis of the APPAC trial
  27. Letters to the Editor
  28. Why a new algorithm using high-sensitivity cardiac troponins for the rapid rule-out of NSTEMI is not adapted to routine practice
  29. Optimal collection tubes for plasma glucose determination: confusion reigns supreme
  30. Long-term stability of serum samples positive for carbohydrate deficient transferrin (CDT) routinely stored at −20 °C
  31. Seasonal variations in plasma free metanephrine concentrations are not evident in the West of Ireland
  32. Potential errors in the determination of urinary ammonium by formol titration
  33. Interference by biological anti-cancer drugs in electrophoretic and immunofixation techniques
  34. A point mutation in the thiopurine S-methyltransferase gene that led to exon 5 deletion in the transcribed mRNA
  35. Detection of the heterozygote of hemoglobin Constant Spring by α-thalassemia immunochromatographic strip test
  36. Automated CH50 liposome-based immunoassay: consideration in dilution and validation of reference interval
  37. Theranos phenomenon – Part 5: Theranos’ presentation at the American Association for Clinical Chemistry Annual Conference 2016
  38. Congress Abstracts
  39. 58th National Congress of the Hungarian Society of Laboratory Medicine
  40. The 4th Joint EFLM-UEMS Congress “Laboratory Medicine at the Clinical Interface” Warsaw, Poland, 21th–24th September, 2016
  41. Congress of Clinical Chemistry and Laboratory Medicine
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