Background: Clinical measures that are used to identify risk for specific diseases may also help physicians predict overall mortality risk in their patients. This study derived and validated a clinical scoring system that can be used to predict all-cause mortality risk in men using age, resting heart rate, blood pressure, total cholesterol, HDL-cholesterol, triglycerides, diabetes, obesity, smoking status, and cardiorespiratory fitness categories.
Methods: This was a cohort-based prospective study of 21,766 men with no prior history of coronary heart disease, stroke, or cancer. Participants were aged 20 to 69 years at the time of their clinical examination between 1979 and 1998. The cohort was subdivided into a derivation group and a validation group. All participants underwent a clinical examination including an exercise test to determine cardiorespiratory fitness. Blood pressure, total and HDL-cholesterol, triglycerides, diabetes, and adiposity status were categorized according to clinical guidelines. Within the derivation group, a point scoring system was developed to predict all-cause mortality based on a proportional hazards regression. The point scoring system was then tested within the validation group. Data were analyzed in January 2005.
Results: For the clinical mortality scoring system, the most points were assigned for greater age (e.g., 10 points for 65- to 69-year-olds), followed by diabetes (4 points), current smoking (4 points), severe obesity (3 points), low fitness (2 points), high resting heart rate (2 points), hypertension (2 points), and former smoking (1 point). A graded relationship was observed between total risk factor points and mortality risk within the derivation group, and the point scoring system accurately predicted mortality risk in the validation group. The discriminatory accuracy of the point scoring system was within acceptable limits in both the derivation group and validation group.
Conclusions: A score sheet for predicting all-cause mortality risk in men, The Cooper Clinic Mortality Risk Index, was derived and validated. This score sheet may help healthcare practitioners identify high-risk patients who might benefit from lifestyle modification, pharmacologic therapy, or other interventions.