Development and Validation of a Pediatric Heart Failure Risk-Prediction Model for Children Listed for Heart Transplantion in the Current Era

Purpose Previous studies have developed validated risk-prediction models for pediatric heart failure (HF). However, ventricular assist device (VAD) use and organ allocation practices have shifted markedly over the last decade for pediatric heart transplant (HT) candidates. We sought to develop and validate a risk-prediction model in a contemporary cohort of pediatric HF patients. Methods Children Results The selected predictive model had 5 categorical variables: mechanical support [ECMO (Odds ratio, OR 6.3), VAD support (OR 1.3), vs no support], ventilator support (OR 2.5), cardiac diagnosis [congenital heart disease (CHD) (OR 2.3), vs. cardiomyopathy], renal dysfunction [dysfunction (OR 2.3), vs. normal], and weight categories at listing [25-50 kg (OR 2.0), 10-25 kg (OR 3.2), 5-10 kg (OR 3.7), and 0-5 kg (OR 5.6), vs. ≥50 kg]. The final model developed using the derivation cohort after internal cross-validation (N=2029; C-statistic 0.83, Hosmer-Lemeshow Goodness of Fit P=0.81) performed well in the independent validation cohort (N=1194, C-statistic 0.81, HL P=0.68), suggesting excellent prediction in a contemporary cohort of pediatric HF patients as shown in the calibration plot in Figure 1. Conclusion This heart failure risk-prediction model using 5 baseline clinical factors at the time of listing has excellent prediction characteristics for 30-day mortality in a contemporary cohort of children. The model may be useful to support decision-making surrounding referral for advanced cardiac therapies including HT and VAD support.