Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS
Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS
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DOI：
10.1046/j.1523-1755.2002.00658.x
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发表时间：
2002-12-01
影响因子：
19.6
通讯作者：
Young, EW
中科院分区：
文献类型：
--
作者：
Pifer, TB;McCullough, KP;Young, EW
背景营养状况与血液透析患者的预后密切相关。我们分析了几个容易测量的营养指标的独立预测价值，包括改良的主观全面评估（mSGA）、体重指数（BMI）、血清白蛋白、血清肌酐、标准化蛋白分解代谢率（nPCR）、血清碳酸氢盐、淋巴细胞计数和中性粒细胞计数，使用基线和6个月的随访测量。研究样本包括参加国际透析结局和实践模式研究（DOPPS）的7719名美国成人血液透析患者，这是一项前瞻性观察性研究，包括来自美国145家透析机构的血液透析患者的随机样本。使用考克斯回归来估计与基线和六个月后测量值差异相关的相对死亡风险。每项分析均根据年龄、种族、性别和15种合并症进行调整。较低的基线mSGA、BMI、血清白蛋白、血清肌酐和淋巴细胞计数与显著较高的死亡风险独立相关。在6个月的随访中，BMI、血清白蛋白和血清肌酐的降低也与死亡风险显著升高相关。死亡风险随基线和6个月中性粒细胞计数升高而增加。这项研究证实，几个易于测量的营养指标可以预测血液透析患者的死亡率，并且六个月内指标值的变化提供了额外的重要预后信息。改变这些营养状态指标的干预措施可能对血液透析患者的生存率有重要影响。
Background. Nutritional status is strongly associated with outcomes among hemodialysis patients. We analyzed the independent predictive value of several readily measured nutritional indicators, including a modified subjective global assessment (mSGA), body mass index (BMI), serum albumin, serum creatinine, normalized protein catabolic rate (nPCR), serum bicarbonate, lymphocyte count, and neutrophil count, using baseline and six-month follow-up measurements.Methods. The study sample consisted of 7719 U.S. adult hemodialysis patients enrolled in the international Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective observational study that includes a random sample of hemodialysis patients from 145 dialysis facilities in the United States. Cox regression was used to estimate the relative risk of mortality associated with differences in measurements at baseline and six months later. Each analysis was adjusted for age, race, sex, and 15 summary comorbid conditions.Results. Lower baseline measurements of mSGA, BMI, serum albumin, serum creatinine, and lymphocyte count were independently associated with significantly higher risk of mortality. During six-month follow-up, decreases in BMI, serum albumin, and serum creatinine were also associated with significantly higher mortality risk. The risk of mortality increased with higher baseline and six-month increases in neutrophil count.Conclusions. This study confirms that several readily-measured nutritional indicators predict mortality among hemodialysis patients and that changes in indicator values over six months provide additional important prognostic information. Interventions that modify these indicators of nutritional status may have an important impact on the survival of hemodialysis patients.