Comparing the Ability of Two Comprehensive Clinical Staging Systems to Predict Mortality: EOSS and CMDS.

Abstract

Differences in discriminative and predictive ability for all-cause mortality of two clinical staging systems, the Edmonton Obesity Staging System (EOSS) and Cardiometabolic Disease Staging (CMDS), were estimated. Data for nonpregnant persons aged 40 to 75 years were extracted from the National Health and Nutrition Examination Survey. Predictive and discriminative ability was assessed using pseudo-R² and C-statistics. Median years of life lost were also computed for each score. Differences in out-of-sample estimates of pseudo-R² and C-statistics (EOSS model as reference) were 0.02 (95% CI: 0.01-0.04) (Kent pseudo-R² ), 0.03 (0.01-0.04) (Royston pseudo-R² ), and 0.02 (0.01-0.02) (C-statistics). The median years of life lost for EOSS scores 2 and 3 (low to high risk) for a reference person were 1.19 and 6.76 years. Those for CMDS scores 1, 2, 3, and 4 (low to high risk) were 1.53, 2.90, 3.91, and 8.51 years. Consistent results from the in-sample estimates were observed. CMDS had statistically significantly greater predictive and discriminative ability than EOSS for persons aged 40 to 75. While the clinical relevance of these differences is unknown, CMDS may have greater clinical utility given that it uses fewer items to risk stratify. The clinical relevance and utility need to be studied further.