Importance of simultaneous evaluation of multiple risk factors for hemodialysis patients' mortality and development of a novel index: dialysis outcomes and practice patterns study.
Importance of simultaneous evaluation of multiple risk factors for hemodialysis patients' mortality and development of a novel index: dialysis outcomes and practice patterns study.
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DOI：
10.1371/journal.pone.0128652
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Fuller DS
中科院分区：
文献类型：
--
作者：
Kanda E;Bieber BA;Pisoni RL;Robinson BM;Fuller DS
对于血液透析（HD）患者来说，许多死亡危险因素彼此错综复杂地相关。然而，在临床环境中，它们通常被单独考虑。我们使用美国透析结果和实践模式研究 (DOPPS) 数据开发的新指数（生存指数，SI），评估了维持性 HD 患者一年内因多种危险因素而死亡的风险，同时考虑到这些因素之间的相互关系。我们分析了 3899 名和 3765 名患者的数据，分别开发和验证 SI。为了预测一年内的死亡，使用逻辑回归模型开发了候选模型。最终模型是通过比较模型预测死亡的准确性来确定的。该模型包括年龄；体重指数；血清肌酐、白蛋白、总胆固醇和磷水平；有心血管疾病史；和动静脉内瘘的使用。 SI 在预测死亡方面（c 统计量，0.739）比老年营养风险指数（0.647）和血清白蛋白水平（0.637）具有更高的准确性。根据 SI 预测的死亡概率与观察到的死亡人数相匹配。时间依赖性 SI 的 Cox 比例风险模型显示，低 SI 患者的死亡风险高于高 SI 患者[参考，第 4 组 (26.1≤SI)]；第 1 组 (SI<12.7)，调整后风险比，7.97 (95% CI, 5.02, 12.65)；第 2 组（12.7≤SI<19.0），3.18（95% CI，1.96，5.16）；第 3 组（19.0≤SI<26.1），2.20（95% CI，1.33，3.66）。这项研究的结果表明，与单一因素相比，同时评估多个危险因素可以更准确地评估患者的预后并识别死亡风险增加的患者。
For hemodialysis (HD) patients, many risk factors for death are associated with each other intricately. However, they are often considered separately in clinical settings. We evaluated the maintenance HD patients’ risk of death within one year from multiple risk factors simultaneously considering their interrelationships using a novel index (survival index, SI) for HD patients in the United States developed using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS). We analyzed data from 3899 and 3765 patients to develop and validate SI, respectively. To predict death within one year, candidate models were developed using logistic regression models. The final model was determined by comparing the accuracy among the models for the prediction of deaths. The model included age; body mass index; serum creatinine, albumin, total cholesterol and phosphorus levels; history of cardiovascular diseases; and arteriovenous fistula use. SI showed a higher accuracy in predicting death (c-statistic, 0.739) than geriatric nutritional risk index (0.647) and serum albumin level (0.637). The probability of death predicted on the basis of SI matched the observed number of deaths. Cox proportional hazard models for time-dependent SI showed that patients with low SI had a higher risk of death than patients with high SI [reference, Group 4 (26.1≤SI)]; Group 1 (SI<12.7), adjusted hazard ratio, 7.97 (95% CI, 5.02, 12.65); Group 2 (12.7≤SI<19.0), 3.18 (95% CI, 1.96, 5.16); Group 3 (19.0≤SI<26.1), 2.20 (95% CI, 1.33, 3.66). Results of this study suggest that the simultaneous evaluation of multiple risk factors can more accurately assess patients’ prognosis and identify patients at an increased risk of death than single factors.
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影响因子：
7.1
作者：
Bouillanne, O;Morineau, G;Aussel, C
通讯作者：
Aussel, C
影响因子：
6.1
作者：
Leavey, SF;McCullough, K;Young, EW
通讯作者：
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DOI：
10.1097/01.asn.0000113319.57131.28
发表时间：
2004-03-01
影响因子：
13.6
作者：
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通讯作者：
Samore, MH
DOI：
10.2215/cjn.05700611
发表时间：
2012-02-01
影响因子：
9.8
作者：
Hoogeveen, Ellen K.;Halbesma, Nynke;de Mutsert, Renee
通讯作者：
de Mutsert, Renee
影响因子：
6.1
作者：
de Mutsert, Renee;Grootendorst, Diana C.;Dekker, Fniedo W.
通讯作者：
Dekker, Fniedo W.