Predicting Six-Month Mortality for Patients Who Are on Maintenance Hemodialysis
Predicting Six-Month Mortality for Patients Who Are on Maintenance Hemodialysis
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DOI：
10.2215/cjn.03860609
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发表时间：
2010-01-01
影响因子：
9.8
通讯作者：
Germain, Michael J.
中科院分区：
文献类型：
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作者：
Cohen, Lewis M.;Ruthazer, Robin;Germain, Michael J.
背景和目标：由于临床准确性的不确定性，肾病学家很少传达预后信息。本研究的目的是为接受血液透析 (HD) 的患者开发 6 个月生存的综合预后模型。设计、设置、参与者和测量：使用来自 512 名在 5 个透析诊所接受 HD 的患者组成的衍生队列的前瞻性数据开发了短期预后模型。审查了患者图表的精算预测因子（例如，查尔森合并症），肾病专家回答了“惊讶”问题 (SQ)：“如果该患者在接下来的 6 个月内死亡，我会感到惊讶吗？”存活率监测长达 24 个月。该预后模型通过来自 8 个诊所的 514 名患者组成的验证队列进行了测试。结果：在衍生队列的 Cox 多变量分析中，五个变量与早期死亡率独立相关：年龄较大（10 年增加的风险比 [HR] 1.36；95% 置信区间 [CI] 1.17 至 1.57）、痴呆（HR 2.24；95% Cl 1.11至4.48）、周围血管疾病（HR 1.88；95% CI 1.24至2.84）、白蛋白减少（1-U增加HR 0.27；95% CI 0.15至0.50）和SQ（HR 2.71；95% CI 1.76至4.17）。由此产生的 6 个月死亡率预后模型预测的曲线下面积在推导队列中为 0.87（95% CI 0.82 至 0.92），在验证队列中为 0.80（95% CI 0.73 至 0.88）。结论：针对 HD 人群开发并验证了综合的 6 个月预后工具。该仪器可能对研究人员和临床医生有价值，可以通过提供更准确的预后信息来改善临终护理。 Clin J Am Soc Nephrol 5: 72-79, 2010.doi: 10.2215/CJN.03860609
Background and objectives: Prognostic information is rarely conveyed by nephrologists because of clinical uncertainty about accuracy. The objective of this study was to develop an integrated prognostic model of 6-mo survival for patients who receive hemodialysis (HD).Design, setting, participants, & measurements: A short-term prognostic model was developed using prospective data from a derivation cohort of 512 patients who were receiving HD at five dialysis clinics. Patient charts were reviewed for actuarial predictors (e.g., Charlson Comorbidity), and nephrologists answered the "surprise" question (SQ), "Would I be surprised if this patient died within the next 6 mo?" Survival was monitored for up to 24 mo. The prognostic model was tested with a validation cohort of 514 patients from eight clinics.Results: In a Cox multivariate analysis of the derivation cohort, five variables were independently associated with early mortality: Older age (hazard ratio [HR] for a 10-yr increase 1.36; 95% confidence interval [CI] 1.17 to 1.57), dementia (HR 2.24; 95% Cl 1.11 to 4.48), peripheral vascular disease (HR 1.88; 95% CI 1.24 to 2.84), decreased albumin (HR for a 1-U increase 0.27; 95% CI 0.15 to 0.50), and SQ (HR 2.71; 95% CI 1.76 to 4.17). Area under the curve for the resulting prognostic model predictions of 6-mo mortality were 0.87 (95% CI 0.82 to 0.92) in the derivation cohort and 0.80 (95% CI 0.73 to 0.88) in the validation cohort.Conclusions: An integrated 6-mo prognostic tool was developed and validated for the HD population. The instrument may be of value for researchers and clinicians to improve end-of-life care by providing more accurate prognostic information. Clin J Am Soc Nephrol 5: 72-79, 2010. doi: 10.2215/CJN.03860609