title: Repeated measurement of the intermountain risk score enhances prognostication for mortality.
abstract: BACKGROUND
  The Intermountain Risk Score (IMRS), composed of the complete blood count (CBC) and basic metabolic profile (BMP), predicts mortality and morbidity in medical and general populations. Whether longitudinal repeated measurement of IMRS is useful for prognostication is an important question for its clinical applicability.
  
  
  METHODS
  Females (N = 5,698) and males (N = 5,437) with CBC and BMP panels measured 6 months to 2.0 years apart (mean 1.0 year) had baseline and follow-up IMRS computed. Survival analysis during 4.0±2.5 years (maximum 10 years) evaluated mortality (females: n = 1,255 deaths; males: n = 1,164 deaths) and incident major events (myocardial infarction, heart failure [HF], and stroke).
  
  
  RESULTS
  Both baseline and follow-up IMRS (categorized as high-risk vs. low-risk) were independently associated with mortality (all p<0.001) in bivariable models. For females, follow-up IMRS had hazard ratio (HR) = 5.23 (95% confidence interval [CI] = 4.11, 6.64) and baseline IMRS had HR = 3.66 (CI = 2.94, 4.55). Among males, follow-up IMRS had HR = 4.28 (CI = 3.51, 5.22) and baseline IMRS had HR = 2.32 (CI = 1.91, 2.82). IMRS components such as RDW, measured at both time points, also predicted mortality. Baseline and follow-up IMRS strongly predicted incident HF in both genders.
  
  
  CONCLUSIONS
  Repeated measurement of IMRS at baseline and at about one year of follow-up were independently prognostic for mortality and incident HF among initially hospitalized patients. RDW and other CBC and BMP values were also predictive of outcomes. Further research should evaluate the utility of IMRS as a tool for clinical risk adjustment.
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA. benjamin.horne@imail.org
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Horne
authors.forename: Donald L
authors.initials: DL
authors.lastname: Lappé
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Muhlestein
authors.forename: Heidi T
authors.initials: HT
authors.lastname: May
authors.forename: Brianna S
authors.initials: BS
authors.lastname: Ronnow
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Brunisholz
authors.forename: Abdallah G
authors.initials: AG
authors.lastname: Kfoury
authors.forename: T Jared
authors.initials: TJ
authors.lastname: Bunch
authors.forename: Rami
authors.initials: R
authors.lastname: Alharethi
authors.forename: Deborah
authors.initials: D
authors.lastname: Budge
authors.forename: Brian K
authors.initials: BK
authors.lastname: Whisenant
authors.forename: Tami L
authors.initials: TL
authors.lastname: Bair
authors.forename: Kurt R
authors.initials: KR
authors.lastname: Jensen
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult