Mortality Prediction by Surrogates of Body Composition: An Examination of the Obesity Paradox in Hemodialysis Patients Using Composite Ranking Score Analysis
Mortality Prediction by Surrogates of Body Composition: An Examination of the Obesity Paradox in Hemodialysis Patients Using Composite Ranking Score Analysis
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DOI：
10.1093/aje/kwr384
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发表时间：
2012-04-15
影响因子：
5
通讯作者：
Greenland, Sander
中科院分区：
文献类型：
--
作者：
Kalantar-Zadeh, Kamyar;Streja, Elani;Greenland, Sander
在血液透析患者中，较低的体重指数和体重减轻与较高的死亡率有关，这种现象有时被称为肥胖悖论。这一明显的悖论可能可以用肌肉质量的下降来解释。因此，作者对121,762名血液透析患者进行了长达5年(2001-2006年)的跟踪调查，研究了干重变化和血肌酐水平(肌肉质量替代指标)变化与死亡率的关系。除了常规的回归分析外，作者还进行了联合效应的排名分析，其中以每个患者两项指标的变化百分位数之和和差异作为回归变量。与以前的体重指数观察结果一致，较低的体重、较低的肌肉质量、体重减轻和血清肌酐下降与较高的死亡率相关。在有不协调变化的患者中，体重下降但血清肌酐水平上升的人的死亡率低于体重增加但血清肌酐水平下降的人。与体重减轻相比，血清肌酐下降似乎是死亡率的更强预测因素。假设剩余选择偏差和混淆不大，目前的结果表明，透析患者肥胖悖论的相当大比例可能可以用肌肉质量下降的量来解释。
In hemodialysis patients, lower body mass index and weight loss have been associated with higher mortality rates, a phenomenon sometimes called the obesity paradox. This apparent paradox might be explained by loss of muscle mass. The authors thus examined the relation to mortality of changes in dry weight and changes in serum creatinine levels (a muscle-mass surrogate) in a cohort of 121,762 hemodialysis patients who were followed for up to 5 years (2001-2006). In addition to conventional regression analyses, the authors conducted a ranking analysis of joint effects in which the sums and differences of the percentiles of change for the 2 measures in each patient were used as the regressors. Concordant with previous body mass index observations, lower body mass, lower muscle mass, weight loss, and serum creatinine decline were associated with higher death rates. Among patients with a discordant change, persons whose weight declined but whose serum creatinine levels increased had lower death rates than did those whose weight increased but whose serum creatinine level declined. A decline in serum creatinine appeared to be a stronger predictor of mortality than did weight loss. Assuming residual selection bias and confounding were not large, the present results suggest that a considerable proportion of the obesity paradox in dialysis patients might be explained by the amount of decline in muscle mass.