New Score Predicts Risk for Death on Heart Transplant List

Investigators developed the US-CRS, which incorporates clinical, laboratory, and hemodynamic data, by adding a predefined set of predictors to the current French-CRS.
The Scientific Registry of Transplant Recipients–based observational study that evaluated the score included US adult heart transplant candidates listed between 2019 and 2022, split by center into training (70%) and test (30%) datasets.
The performance of the US-CRS model, French-CRS model, and 6-status model was evaluated by time-dependent area under the receiver operating characteristic curve (AUC) for death without transplant within 6 weeks and overall survival concordance with the integrated AUC.

A total of 16,905 heart transplant candidates (mean age, 53 years; 73% male; 58% White) were listed in the registry during the study period, and 796 patients (4.7%) died without a transplant.
The final US-CRS model included time-varying short-term mechanical circulatory support (ventricular assist–extracorporeal membrane oxygenation or temporary surgical ventricular-assist device), the log of bilirubin, estimated glomerular filtration rate, the log of B-type natriuretic peptide, albumin, sodium, and presence of a durable left ventricular assist device.
In the test dataset, the AUC for death within 6 weeks of listing was 0.79 for the US-CRS model, 0.72 for the French-CRS model, and 0.68 for the 6-status model.
The overall concordance index was 0.76 for the US-CRS model, 0.69 for the French-CRS model, and 0.67 for the 6-status model.

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