Diagnostic accuracy of measurement methods to assess non-adherence to immunosuppressive drugs in kidney transplant recipients
Diagnostic accuracy of measurement methods to assess non-adherence to immunosuppressive drugs in kidney transplant recipients
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DOI：
10.1111/j.1600-6143.2007.02127.x
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发表时间：
2008-03-01
影响因子：
8.8
通讯作者：
De Geest, S.
中科院分区：
文献类型：
--
作者：
Schaefer-Keller, P.;Steiger, J.;De Geest, S.
对免疫抑制治疗不依从性（NAH）的有效评估至关重要：NAH与阴性移植结局相关。我们研究了检测的诊断准确性，患者自我报告和临床医生的附带报告，并使用电子监测（EM）作为参考标准的复合依从性scores.This横断面研究包括249名成人肾移植受者（Ktx）的方便样本（女性：43.4%;平均年龄53.6 [SD：12.7]，中位数7年[IQR：9年]后Ktx）。NAH的评估使用EM超过3个月（即参考标准），环孢霉素，他克莫司，霉酚酸酯，患者的自我报告和临床医生的间接报告的测定。NAH的患病率在测量方法中分别为EM：17.3%;测定：33%（环孢素：25.8%;他克莫司：35.1%;霉酚酸酯：40.2%）;自我报告：12.4%;间接报告：24.9%和复合依从性评分：38.9%。复合依从性评分和侧支报告显示对NAH的敏感性最高和最低（分别为72.1%和15.8%）。至少3名临床医生的间接报告的特异性最高（93.1%）。复合依从性评分阳性的似然比为2.74，没有指标显示出高敏感性和高特异性。结合措施提高了诊断的准确性，表明临床和研究目的的联合措施的相关性。
Valid assessment of immunosuppressive therapy non-adherence (NAH) is vital: NAH is associated with negative transplantation outcomes. We studied the diagnostic accuracy of assay, patient self-reports and clinicians' collateral reports and composite adherence scores using electronic monitoring (EM) as a reference standard.This cross-sectional study included a convenience sample of 249 adult kidney transplant recipients (Ktx) (female: 43.4%; mean age 53.6 [SD: 12.7], median 7 years [IQR: 9 years] post-Ktx). NAH was assessed using EM over 3 months (i.e. reference standard), assays of cyclosporine, tacrolimus, mycophenolat-mofetil, patients' self-reports and clinicians' collateral reports. The constructed composite adherence score included assay, self-reports and collateral reports.NAH's prevalence across the measurement methods was EM: 17.3%; assay: 33% (cyclosporine: 25.8%; tacrolimus: 35.1%; mycophenolat-mofetil: 40.2%); self-report: 12.4%; collateral reports: 24.9% and composite adherence score: 38.9%, respectively. The composite adherence score and collateral reports showed the highest and lowest sensitivities to NAH (72.1% and 15.8%, respectively). Specificity was highest for collateral reports of at least three clinicians (93.1%). Likelihood ratio of a positive test was 2.74 for composite adherence score.No measures showed high sensitivity alongside high specificity. Combining measures increased diagnostic accuracy, indicating the relevance of combined measures for clinical and research purposes.