Frailty, Length of Stay, and Mortality in Kidney Transplant Recipients A National Registry and Prospective Cohort Study
Frailty, Length of Stay, and Mortality in Kidney Transplant Recipients A National Registry and Prospective Cohort Study
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DOI：
10.1097/sla.0000000000002025
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发表时间：
2017-12-01
影响因子：
9
通讯作者：
Segev, Dorry L.
中科院分区：
文献类型：
--
作者：
McAdams-DeMarco, Mara A.;King, Elizabeth A.;Segev, Dorry L.
目的：为了测试是否虚弱，一种新的生理储备措施，与较长的肾移植（KT）住院时间（LOS），并修改LOS和mortality.Background之间的关联：更好地了解LOS是必要的知情同意和出院计划。较长LOS导致的死亡率对医院和移植计划具有重要的监管意义。哪些受者有延长LOS的风险及其对死亡率的影响尚不清楚。虚弱是KT预后不良的一个新的术前预测因子，包括移植肾功能延迟恢复、早期再入院、免疫抑制不耐受和死亡率。我们使用登记增强混合方法（一种新型风险调整方法）来调整移植受者科学登记处的LOS风险因素（n = 74，859），并测试（1）在一个新队列（n = 589）中，在KT前即刻测量的虚弱是否与LOS相关（LOS：负二项回归; LOS >= 2周：逻辑回归）和（2）虚弱是否改变了LOS和死亡率之间的关联结果：虚弱与较长的LOS独立相关[相对危险度= 1.15，95%可信区间（CI）：1.03-1.29; P = 0.01]和LOS >= 2周（比值比= 1.57，95%CI：1.06-2.33; P = 0.03），考虑了基于登记的风险因素，包括移植物功能延迟。虚弱也减弱了LOS和死亡率之间的相关性（非虚弱危险率= 1.55，95%CI：1.30-1.86; P < 0.001;虚弱危险率= 0.97，95%CI：0.79-1.19，P = 0.80;相互作用P = 0.001）。非虚弱受者的LOS时间延长可能是死亡风险增加的标志。虚弱是生理储备的一种量度，可能是手术LOS较长的一个重要临床标志。
Objective: To test whether frailty, a novel measure of physiologic reserve, is associated with longer kidney transplant (KT) length of stay (LOS), and modifies the association between LOS and mortality.Background: Better understanding of LOS is necessary for informed consent and discharge planning. Mortality resulting from longer LOS has important regulatory implications for hospital and transplant programs. Which recipients are at risk of prolonged LOS and its effect on mortality are unclear. Frailty is a novel preoperative predictor of poor KT outcomes including delayed graft function, early hospital readmission, immunosuppression intolerance, and mortality.Methods: We used registry-augmented hybrid methods, a novel approach to risk adjustment, to adjust for LOS risk factors from the Scientific Registry of Transplant Recipients (n = 74,859) and tested whether (1) frailty, measured immediately before KT in a novel cohort (n = 589), was associated with LOS (LOS: negative binomial regression; LOS >= 2 weeks: logistic regression) and (2) whether frailty modified the association between LOS and mortality (interaction term analysis).Results: Frailty was independently associated with longer LOS [relative risk = 1.15, 95% confidence interval (CI): 1.03-1.29; P = 0.01] and LOS >= 2 weeks (odds ratio = 1.57, 95% CI: 1.06-2.33; P = 0.03) after accounting for registry-based risk factors, including delayed graft function. Frailty also attenuated the association between LOS and mortality (nonfrail hazard rate = 1.55 95% CI: 1.30-1.86; P < 0.001; frail hazard rate = 0.97, 95% CI: 0.79-1.19, P = 0.80; P for interaction = 0.001).Conclusions: Frail KT recipients are more likely to experience a longer LOS. Longer LOS among nonfrail recipients may be a marker of increased mortality risk. Frailty is a measure of physiologic reserve that may be an important clinical marker of longer surgical LOS.