Routine CBC Could Provide Added Mortality Risk Information
A risk score based on age and the components of a complete blood count (CBC) is strongly associated with all-cause mortality risk and cardiovascular-specific outcomes in an apparently healthy population, according to a study presented at the American Heart Association Scientific Sessions (Dallas; Nov. 16-20). The researchers say the commonly used blood test could be […]
A risk score based on age and the components of a complete blood count (CBC) is strongly associated with all-cause mortality risk and cardiovascular-specific outcomes in an apparently healthy population, according to a study presented at the American Heart Association Scientific Sessions (Dallas; Nov. 16-20). The researchers say the commonly used blood test could be inexpensively incorporated into laboratory results, electronic medical records, and physician workflow to better identify previously unidentified high-risk individuals who would benefit from costly workups or preventive therapies. The value of the CBC risk score was previously validated in general medical, hospitalized patients, but now researchers have shown the score to be generalizable to a larger, healthier population. They prospectively validated the score for use in individuals initially free of cardiovascular disease participating in a clinical trial, “Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER)” (females, n=6,568 and males, n=10,629). The researchers found that even after adjusting for age, all-cause mortality was significantly higher in middle-risk and high-risk participants, compared to the lowest-risk participants. Risk of death was 50 percent higher in those with middle risk and nearly twice as high in the highest-risk participants, compared to the lowest-risk. For cardiovascular mortality the CBC risk score was also significantly predictive. Risk scores have been underutilized in actual practice, often because they add complexity and time to a physicians’ workload, lead author Benjamin Horne, Ph.D., says. In the case of the CBC risk score, he tells DTET that the CBC risk score is inexpensive both financially, because most individuals get the CBC panel as part of routine care anyway, and because it doesn’t add complexity in time or effort for physicians in medical practice. “Physicians can tell you high cholesterol and high blood pressure and smoking are risk factors, but they don’t put it into a calculator to figure out the 10-year risk,” says Horne, director of cardiovascular and genetic epidemiology at Intermountain Medical Center Heart Institute in Salt Lake City. “We now have a standardized, quantifiable way of assessing the risk of mortality for all individuals.” Horne says that Intermountain is now reporting the risk score electronically, both in lab reports and in electronic medical records based on lab results reported in the past 30 days. While the evidence is not yet there to start ordering CBC tests when not already utilized in practice, Horne says that in patients where CBC panels are routinely ordered including in hospital patients, the risk score can be easily implemented and can aid in identifying apparently healthy individuals at increased risk of mortality who may benefit from additional testing or standard prevention therapies. Takeaway: Incorporating a risk score into CBC results is a way that laboratories can inexpensively provide additional value to ordering physicians and the broader health care system by aiding in better management of individual care and stewardship of health care resources.