Abstract Aims In atrial fibrillation (AF), mortality remains high despite effective anticoagulation. A model predicting the risk of death in these patients is currently not available. We developed and validated a risk score for death in anticoagulated patients with AF including both clinical information and biomarkers. Methods and results The new risk score was developed and internally validated in 14 611 patients with AF randomized to apixaban vs. warfarin for a median of 1.9 years. External validation was performed in 8548 patients with AF randomized to dabigatran vs. warfarin for 2.0 years. Biomarker samples were obtained at study entry. Variables significantly contributing to the prediction of all-cause mortality were assessed by Cox-regression. Each variable obtained a weight proportional to the model coefficients. There were 1047 all-cause deaths in the derivation and 594 in the validation cohort. The most important predictors of death were N-terminal pro B-type natriuretic peptide, troponin-T, growth differentiation factor-15, age, and heart failure, and these were included in the ABC (Age, Biomarkers, Clinical history)-death risk score. The score was well-calibrated and yielded higher c-indices than a model based on all clinical variables in both the derivation (0.74 vs. 0.68) and validation cohorts (0.74 vs. 0.67). The reduction in mortality with apixaban was most pronounced in patients with a high ABC-death score. Conclusion A new biomarker-based score for predicting risk of death in anticoagulated AF patients was developed, internally and externally validated, and well-calibrated in two large cohorts. The ABC-death risk score performed well and may contribute to overall risk assessment in AF. ClinicalTrials.gov identifier NCT00412984 and NCT00262600

中文翻译：

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用于预测房颤患者死亡的基于生物标志物的风险评分：ABC（年龄、生物标志物、临床病史）死亡风险评分

摘要 目的 在房颤 (AF) 中，尽管进行了有效的抗凝治疗，但死亡率仍然很高。目前还没有预测这些患者死亡风险的模型。我们开发并验证了 AF 抗凝患者的死亡风险评分，包括临床信息和生物标志物。方法和结果 新的风险评分是在 14611 名随机接受阿哌沙班与华法林治疗的 AF 患者中开发和内部验证的，中位时间为 1.9 年。对 8548 名随机接受达比加群与华法林治疗 2.0 年的 AF 患者进行了外部验证。生物标志物样品在研究开始时获得。通过 Cox 回归评估对全因死亡率预测有显着贡献的变量。每个变量获得一个与模型系数成正比的权重。推导中有 1047 例全因死亡，验证队列中有 594 例。死亡的最重要预测因子是 N 端前 B 型利钠肽、肌钙蛋白-T、生长分化因子-15、年龄和心力衰竭，这些都被列入 ABC（年龄、生物标志物、临床病史）-死亡风险评分。与基于推导（0.74 对 0.68）和验证队列（0.74 对 0.67）中所有临床变量的模型相比，该评分经过良好校准并产生更高的 c 指数。在 ABC 死亡评分高的患者中，阿哌沙班对死亡率的降低最为明显。结论 开发了一种新的基于生物标志物的评分来预测抗凝 AF 患者的死亡风险，经过内部和外部验证，并在两个大型队列中进行了良好校准。ABC 死亡风险评分表现良好，可能有助于 AF 的整体风险评估。ClinicalTrials.gov 标识符 NCT00412984 和 NCT00262600