Development and validation of an all-cause mortality risk score in type 2 diabetes
Development and validation of an all-cause mortality risk score in type 2 diabetes
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DOI：
10.1001/archinte.168.5.451
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发表时间：
2008-03-10
影响因子：
--
通讯作者：
Chan, Juliana C. N.
中科院分区：
文献类型：
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作者：
Yang, Xilin;So, Wing Yee;Chan, Juliana C. N.
背景：糖尿病使预期寿命缩短 10 至 12 年，但 2 型糖尿病的死亡是否可以预测仍不确定。 方法：自 1995 年以来入组的 7583 名 2 型糖尿病患者前瞻性队列于 2005 年 7 月 30 日或 6 年后随访（以先到者为准）进行审查。使用受限三次样条模型来检查数据线性并开发线性变换公式。数据被随机分配到训练数据集和测试数据集。 Cox 模型用于在测试数据集中开发风险评分。在测试数据集中评估校准和歧视。结果：在中位随访期 5.51 年中，共有 619 名患者死亡，死亡率为每 1000 人年 18.69 人。年龄、性别、外周动脉疾病、癌症病史、胰岛素使用、血红蛋白水平、线性变换体重指数、随机点尿白蛋白-肌酐比以及入组时估计肾小球滤过率是全因死亡的预测因素。使用这些预测因素制定了全因死亡率的风险评分。测试数据集中的预测死亡率和观察到的死亡率相似 (P > .70)。 5 年随访期间受试者工作特征曲线下面积为 0.85。使用风险评分对特定原因死亡进行排序，受试者工作特征曲线下面积对于泌尿生殖系统死亡为 0.95，对于循环系统死亡为 0.85，对于呼吸系统死亡为 0.85，对于肿瘤死亡为 0.71。 结论：2 型糖尿病的死亡可以使用由常用测量的临床和生化变量组成的风险评分进行预测。临床使用前还需进一步验证。
Background: Diabetes reduces life expectancy by 10 to 12 years, but whether death can be predicted in type 2 diabetes mellitus remains uncertain.Methods: A prospective cohort of 7583 type 2 diabetic patients enrolled since 1995 were censored on July 30, 2005, or after 6 years of follow-up, whichever came first. A restricted cubic spline model was used to check data linearity and to develop linear-transforming formulas. Data were randomly assigned to a training data set and to a test data set. A Cox model was used to develop risk scores in the test data set. Calibration and discrimination were assessed in the test data set.Results: A total of 619 patients died during a median follow-up period of 5.51 years, resulting in a mortality rate of 18.69 per 1000 person-years. Age, sex, peripheral arterial disease, cancer history, insulin use, blood hemoglobin levels, linear-transformed body mass index, random spot urinary albumin-creatinine ratio, and estimated glomerular filtration rate at enrollment were predictors of all-cause death. A risk score for all-cause mortality was developed using these predictors. The predicted and observed death rates in the test data set were similar (P > .70). The area under the receiver operating characteristic curve was 0.85 for 5 years of follow-up. Using the risk score in ranking cause-specific deaths, the area under the receiver operating characteristic curve was 0.95 for genitourinary death, 0.85 for circulatory death, 0.85 for respiratory death, and 0.71 for neoplasm death.Conclusions: Death in type 2 diabetes mellitus can be predicted using a risk score consisting of commonly measured clinical and biochemical variables. Further validation is needed before clinical use.