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Out-of-Sample Validity of the PROLOGUE Score to Predict Neurologic Function after Cardiac Arrest

Background: The clinical value of a prognostic score depends on its out-of-sample validity because inaccurate outcome prediction can be not only useless but potentially fatal. We aimed to evaluate the out-of-sample validity of a recently developed and highly accurate Korean prognostic score for pred...

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Autores principales: Schriefl, Christoph, Schoergenhofer, Christian, Buchtele, Nina, Mueller, Matthias, Poppe, Michael, Clodi, Christian, Ettl, Florian, Merrelaar, Anne, Boegl, Magdalena Sophie, Steininger, Philipp, Holzer, Michael, Herkner, Harald, Schwameis, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9225634/
https://www.ncbi.nlm.nih.gov/pubmed/35743661
http://dx.doi.org/10.3390/jpm12060876
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author Schriefl, Christoph
Schoergenhofer, Christian
Buchtele, Nina
Mueller, Matthias
Poppe, Michael
Clodi, Christian
Ettl, Florian
Merrelaar, Anne
Boegl, Magdalena Sophie
Steininger, Philipp
Holzer, Michael
Herkner, Harald
Schwameis, Michael
author_facet Schriefl, Christoph
Schoergenhofer, Christian
Buchtele, Nina
Mueller, Matthias
Poppe, Michael
Clodi, Christian
Ettl, Florian
Merrelaar, Anne
Boegl, Magdalena Sophie
Steininger, Philipp
Holzer, Michael
Herkner, Harald
Schwameis, Michael
author_sort Schriefl, Christoph
collection PubMed
description Background: The clinical value of a prognostic score depends on its out-of-sample validity because inaccurate outcome prediction can be not only useless but potentially fatal. We aimed to evaluate the out-of-sample validity of a recently developed and highly accurate Korean prognostic score for predicting neurologic outcome after cardiac arrest in an independent, plausibly related sample of European cardiac arrest survivors. Methods: Analysis of data from a European cardiac arrest center, certified in compliance with the specifications of the German Council for Resuscitation. The study sample included adults with nontraumatic out-of-hospital cardiac arrest admitted between 2013 and 2018. Exposure was the PROgnostication using LOGistic regression model for Unselected adult cardiac arrest patients in the Early stages (PROLOGUE) score, including 12 clinical variables readily available at hospital admission. The outcome was poor 30-day neurologic function, as assessed using the cerebral performance category scale. The risk of a poor outcome was calculated using the PROLOGUE score regression equation. Predicted risk deciles were compared to observed outcome estimates in a complete-case analysis, a best-case analysis, and a multiple-data-imputation analysis using the Markov chain Monte Carlo method. Results: A total of 1051 patients (median 61 years, IQR 50–71; 29% female) were analyzed. A total of 808 patients (77%) were included in the complete-case analysis. The PROLOGUE score overestimated the risk of poor neurologic outcomes in the range of 40% to 100% predicted risk, involving 63% of patients. The model fit did not improve after missing data imputation. Conclusions: In a plausibly related sample of European cardiac arrest survivors, risk prediction by the PROLOGUE score was largely too pessimistic and failed to replicate the high accuracy found in the original study. Using the PROLOGUE score as an example, this study highlights the compelling need for independent validation of a proposed prognostic score to prevent potentially fatal mispredictions.
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spelling pubmed-92256342022-06-24 Out-of-Sample Validity of the PROLOGUE Score to Predict Neurologic Function after Cardiac Arrest Schriefl, Christoph Schoergenhofer, Christian Buchtele, Nina Mueller, Matthias Poppe, Michael Clodi, Christian Ettl, Florian Merrelaar, Anne Boegl, Magdalena Sophie Steininger, Philipp Holzer, Michael Herkner, Harald Schwameis, Michael J Pers Med Article Background: The clinical value of a prognostic score depends on its out-of-sample validity because inaccurate outcome prediction can be not only useless but potentially fatal. We aimed to evaluate the out-of-sample validity of a recently developed and highly accurate Korean prognostic score for predicting neurologic outcome after cardiac arrest in an independent, plausibly related sample of European cardiac arrest survivors. Methods: Analysis of data from a European cardiac arrest center, certified in compliance with the specifications of the German Council for Resuscitation. The study sample included adults with nontraumatic out-of-hospital cardiac arrest admitted between 2013 and 2018. Exposure was the PROgnostication using LOGistic regression model for Unselected adult cardiac arrest patients in the Early stages (PROLOGUE) score, including 12 clinical variables readily available at hospital admission. The outcome was poor 30-day neurologic function, as assessed using the cerebral performance category scale. The risk of a poor outcome was calculated using the PROLOGUE score regression equation. Predicted risk deciles were compared to observed outcome estimates in a complete-case analysis, a best-case analysis, and a multiple-data-imputation analysis using the Markov chain Monte Carlo method. Results: A total of 1051 patients (median 61 years, IQR 50–71; 29% female) were analyzed. A total of 808 patients (77%) were included in the complete-case analysis. The PROLOGUE score overestimated the risk of poor neurologic outcomes in the range of 40% to 100% predicted risk, involving 63% of patients. The model fit did not improve after missing data imputation. Conclusions: In a plausibly related sample of European cardiac arrest survivors, risk prediction by the PROLOGUE score was largely too pessimistic and failed to replicate the high accuracy found in the original study. Using the PROLOGUE score as an example, this study highlights the compelling need for independent validation of a proposed prognostic score to prevent potentially fatal mispredictions. MDPI 2022-05-26 /pmc/articles/PMC9225634/ /pubmed/35743661 http://dx.doi.org/10.3390/jpm12060876 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Schriefl, Christoph
Schoergenhofer, Christian
Buchtele, Nina
Mueller, Matthias
Poppe, Michael
Clodi, Christian
Ettl, Florian
Merrelaar, Anne
Boegl, Magdalena Sophie
Steininger, Philipp
Holzer, Michael
Herkner, Harald
Schwameis, Michael
Out-of-Sample Validity of the PROLOGUE Score to Predict Neurologic Function after Cardiac Arrest
title Out-of-Sample Validity of the PROLOGUE Score to Predict Neurologic Function after Cardiac Arrest
title_full Out-of-Sample Validity of the PROLOGUE Score to Predict Neurologic Function after Cardiac Arrest
title_fullStr Out-of-Sample Validity of the PROLOGUE Score to Predict Neurologic Function after Cardiac Arrest
title_full_unstemmed Out-of-Sample Validity of the PROLOGUE Score to Predict Neurologic Function after Cardiac Arrest
title_short Out-of-Sample Validity of the PROLOGUE Score to Predict Neurologic Function after Cardiac Arrest
title_sort out-of-sample validity of the prologue score to predict neurologic function after cardiac arrest
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9225634/
https://www.ncbi.nlm.nih.gov/pubmed/35743661
http://dx.doi.org/10.3390/jpm12060876
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