Construct validity of the definition of primary graft dysfunction after lung transplantation
Construct validity of the definition of primary graft dysfunction after lung transplantation
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DOI：
10.1016/j.healun.2010.05.013
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发表时间：
2010-11-01
影响因子：
8.9
通讯作者：
Kawut, Steven M.
中科院分区：
文献类型：
--
作者：
Christie, Jason D.;Bellamy, Scarlett;Kawut, Steven M.
背景技术背景：本研究测试了判别效度的国际社会的心脏和肺移植（ISHLT）原发性移植物功能障碍（PGD）等级与肺损伤生物标志物档案和survival.METHODS：研究样本包括一个多中心的前瞻性队列研究的生物标志物分析和队列研究的450例患者的死亡率分析。根据移植后24、48和72小时的ISHLT共识定义POD。我们使用纵向数据模型比较了PGD分级之间急性肺损伤血浆标志物的变化。为了检验预测有效性，我们根据POD分级比较了30天死亡率和长期生存率的差异。在24、48、49、肺移植后72小时与术后1、2、3、4、6、7、8、12、14、18、19、3级具有最高的30天（趋势检验p < 0.001）和总死亡率（对数秩p < 0.001），POD I级和2级显示中等死亡率风险。随着分级时间远离移植时间，区分30天死亡率和总体死亡率的能力得到提高（趋势检验p < 0.001）。结论：基于肺损伤和死亡率的血浆标志物，ISHLT分级系统具有良好的判别效度。3级POD与最严重改变的血浆生物标志物特征和最差结局相关，无论分级的时间点如何。48和72小时的POD等级比24小时的PGD等级更好地区分死亡率。J Heart Lung Transplant 2010;29：1231-9（C）2010国际心肺移植学会。All rights reserved.
BACKGROUND: This study tested the discriminant validity of International Society for Heart and Lung Transplantation (ISHLT) primary graft dysfunction (PGD) grades with lung injury biomarker profiles and survival.METHODS: The study samples consisted of a multicenter prospective cohort study for the biomarker analysis and a cohort study of 450 patients for the mortality analyses. POD was defined according to ISHLT consensus at 24, 48, and 72 hours after transplantation. We compared the changes in plasma markers of acute lung injury between PGD grades using longitudinal data models. To test predictive validity, we compared differences in the 30-day mortality and long-term survival according to POD grade.RESULTS: POD Grade 3 demonstrated greater differences between plasma intercellular adhesion molecule 1 (ICAM-1), protein C, and plasminogen activator inhibitor type I (PAI-1) levels than did POD Grades 0 to 2 at 24, 48, and 72 hours after lung transplantation (p < 0.05 for each). Grade 3 had the highest 30-day (test for trend p < 0.001) and overall mortality (log rank p < 0.001), with POD Grades I and 2 demonstrating intermediate risks of mortality. The ability to discriminate both 30-day and overall mortality improved as the time of grading moved away from the time of transplantation (test for trend p < 0.001).CONCLUSIONS: The ISHLT grading system has good discriminant validity, based on plasma markers of lung injury and mortality. Grade 3 POD was associated with the most severely altered plasma biomarker profile and the worst outcomes, regardless of the time point of grading. POD grade at 48 and 72 hours discriminated mortality better than PGD grade at 24 hours. J Heart Lung Transplant 2010;29:1231-9 (C) 2010 International Society for Heart and Lung Transplantation. All rights reserved.