Aims

We probed whether the addition of hemoglobin (HGB) or the female sex (SEX) as variables would provide additional prognostic value to the APPLE score.

Methods

An optimized APPLE score was used to evaluate the AF recurrence risk in the consecutive populations with AF post-catheter ablation including the development (n=562) and validation (n=239) cohorts.

Results

In the populations of AF recurrence, most patients were female sex (103/164, 62.8%), and had the lower HGB levels. After adjusting for the APPLE score, HGB level (Odds Ratio [OR], 0.828; 95% Confidence Interval [CI], 0.749–0.915; P<0.001) and female sex (OR, 1.596; 95% CI, 1.140-2.235; P=0.006) independently predicted AF recurrence. Adjusting the APPLE score by HGB variable improved its predictive ability for AF recurrence (C-statistic value from 0.675 to 0.711, P=0.010), which also increased the C-indexes in the external validation (from 0.653 to 0.725, p=0.023). Female sex variable also enhanced the C-statistic value of the APPLE score for AF recurrence at the both development and external validation (C-indices from 0.675 to 0.691, P=0.004; C-indices from 0.653 to 0.704, p=0.037, respectively). Decision curve analysis showed that the HGB plus APPLE score was better than the SEX plus APPLE score in predicting AF recurrence in two following AF populations.

Conclusion

Inclusion of HGB level and female sex variables improved the predictability and clinical usefulness of adjusted APPLE score. Adjustment of the APPLE score by HGB levels may provide better predictive value than inclusion of the female sex variable.

中文翻译：

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包括血红蛋白水平和女性性别在内，APPLE 评分为导管消融后心房颤动复发提供了额外的预测价值

目标

我们探讨了添加血红蛋白 (HGB) 或女性 (SEX) 作为变量是否会给 APPLE 评分提供额外的预后价值。

方法

使用优化的 APPLE 评分来评估 AF 导管消融后连续人群的 AF 复发风险，包括开发组 (n=562) 和验证组 (n=239)。

结果

在房颤复发人群中，大多数患者为女性（103/164，62.8%），且HGB水平较低。调整 APPLE 评分、HGB 水平（优势比 [OR]，0.828；95% 置信区间 [CI]，0.749–0.915；P<0.001）和女性性别（OR，1.596；95% CI，1.140-2.235； P=0.006) 独立预测 AF 复发。通过HGB变量调整APPLE评分提高了其对AF复发的预测能力（C统计值从0.675到0.711，P=0.010），这也提高了外部验证中的C指数（从0.653到0.725，p=0.023） 。女性性别变量还提高了开发和外部验证时 AF 复发的 APPLE 评分的 C 统计值（C 指数分别为 0.675 至 0.691，P=0.004；C 指数分别为 0.653 至 0.704，p=0.037） ）。决策曲线分析表明，在预测以下两个 AF 人群的 AF 复发方面，HGB 加 APPLE 评分优于 SEX 加 APPLE 评分。

结论

HGB 水平和女性性别变量的纳入提高了调整后 APPLE 评分的可预测性和临床实用性。通过 HGB 水平调整 APPLE 评分可能比包含女性性别变量提供更好的预测价值。