PREDICTION OF MORTALITY IN PATIENTS WITH CYSTIC-FIBROSIS
PREDICTION OF MORTALITY IN PATIENTS WITH CYSTIC-FIBROSIS
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DOI：
10.1056/nejm199204303261804
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发表时间：
1992-04-30
影响因子：
158.5
通讯作者：
LEVISON, H
中科院分区：
文献类型：
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作者：
KEREM, E;REISMAN, J;LEVISON, H
背景大多数囊性纤维化患者在成年早期死于肺病。肺移植是晚期肺病患者的一种治疗选择，尽管器官的等待期可能长达两年。我们的目的是确定是否可以根据肺功能、血气水平和营养状况提前1年或2年预测呼吸衰竭导致的死亡风险。研究队列包括1977年至1989年随访的673例患者。在1977年至1987年期间，对每例患者的肺功能、血气水平、营养状况和生命状态进行了评估。考克斯比例风险回归分析用于计算特定测量后一年或两年内死亡的相对风险。年龄和性别对死亡率的影响也包括在分析中。190名患者（28%）在研究期间死亡。总体而言，一秒用力呼气量（FEV 1）小于预测值的30%，动脉血氧分压低于55 mm Hg或动脉二氧化碳分压高于50 mm Hg的患者两年死亡率高于56%。在实验室测量中，FEV 1是死亡率最重要的预测因子，但年龄和性别在预测风险方面也具有重要意义。校正年龄和性别后，FEV 1每降低10%，两年内死亡的相对风险为2.0（95%置信区间为1.9 ~ 2.2）。在具有相同FEV 1的患者中，与其他患者相比，年龄小于10岁的患者的死亡相对风险为2.0（95%置信区间，1.5至2.6），女性患者与男性患者相比为2.2（1.6至3.1）。当FEV 1福尔斯低于预测值的30%时，囊性纤维化患者应考虑肺移植的候选人。女性患者和年轻患者可能需要在早期考虑移植。
Background. The majority of patients with cystic fibrosis die in early adulthood of lung disease. Lung transplantation is a treatment option for patients with advanced pulmonary disease, although the waiting period for organs may be as long as two years. Our purpose was to determine whether the risk of death due to respiratory failure could be predicted one or two years in advance on the basis of pulmonary function, blood gas levels, and nutritional status.Methods. The study cohort consisted of 673 patients followed between 1977 and 1989. In each patient, pulmonary function, blood gas levels, nutritional status, and vital status were assessed between 1977 and 1987. Cox proportional-hazards regression analysis was used to compute the relative risk of death within one or two years after particular measurements. The effects of age and sex on mortality were also included in the analysis.Results. One hundred ninety patients (28 percent) died during the study period. Overall, patients with a forced expiratory volume in one second (FEV1) less than 30 percent of the predicted value, a partial pressure of arterial oxygen below 55 mm Hg, or a partial pressure of arterial carbon dioxide above 50 mm Hg had two-year mortality rates above 56 percent. Among the laboratory measurements, the FEV1 was the most significant predictor of mortality, but age and sex were also significant in predicting risk. After adjustment for age and sex, the relative risk of death within two years was 2.0 (95 percent confidence interval, 1.9 to 2.2) for each decrement in the FEV1 of 10 percent below the predicted value. Among patients with the same FEV1, the relative risk of death was 2.0 (95 percent confidence interval, 1.5 to 2.6) in patients 10 years younger than other patients, and 2.2 (1.6 to 3.1) in female patients as compared with male patients.Conclusions. Patients with cystic fibrosis should be considered candidates for lung transplantation when the FEV1 falls below 30 percent of the predicted value. Female patients and younger patients may need to be considered for transplantation at an earlier stage.