Measures of Global Health Status on Dialysis Signal Early Rehospitalization Risk after Kidney Transplantation.
Measures of Global Health Status on Dialysis Signal Early Rehospitalization Risk after Kidney Transplantation.
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DOI：
10.1371/journal.pone.0156532
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Reese PP
中科院分区：
文献类型：
--
作者：
Harhay MN;Hill AS;Wang W;Even-Shoshan O;Mussell AS;Bloom RD;Feldman HI;Karlawish JH;Silber JH;Reese PP
肾移植 (KT) 出院后早期再住院（<30 天）与不良预后相关。我们探索了移植前健康状况的汇总指标，这些指标可能有助于识别移植后有早期再住院和死亡风险的 KT 受者。我们对 2000 年至 2010 年间在美国移植中心接受 KT 的 8,870 名成人（≥ 18 岁）血液透析患者进行了一项回顾性队列研究。我们将 Medicare 数据与联合器官共享网络数据和来自全国透析提供者的数据相关联，以检查 KT 前的 (1) Elixhauser 合并症指数、(2) 通过简表 36 健康调查测量的身体机能 (PF)，以及 (3) KT 前 12 个月内的住院次数，作为 KT 后早期再住院的潜在预测因素。我们还探讨了这些指标是否会混淆早期再住院与移植后死亡率之间已知的关联。中位年龄为 52 岁（四分位距 [IQR] 41, 60），63% 为男性。 29% 在 30 天内再次住院，20% 在中位随访时间五年内死亡（IQR 3.6-6.5）。在多变量逻辑模型中，KT 前 Elixhauser 合并症较多（每种合并症调整后比值比 [aOR] 1.09，95% 置信区间 [CI] 1.07–1.11）、KT 前 PF 最差（aOR 1.24、95% CI 1.08–1.43）或 >1 KT 前的肾受者住院治疗（aOR 1.32，95% CI 1.17-1.49）更有可能再次住院。在多变量 Cox 模型中，所有三种健康状况指标和早期再住院均与 KT 后死亡率独立相关（调整后的再住院风险比：1.41，95% CI 1.28–1.56）由透析提供者或管理数据测量的移植前健康状况指标与 KT 后早期再住院和死亡风险独立相关。移植提供者可以考虑利用 KT 前全球健康状况指标作为 KT 后过渡护理时脆弱性的早期信号。
Early rehospitalization (<30 days) after discharge from kidney transplantation (KT) is associated with poor outcomes. We explored summary metrics of pre-transplant health status that may improve the identification of KT recipients at risk for early rehospitalization and mortality after transplant. We performed a retrospective cohort study of 8,870 adult (≥ 18 years) patients on hemodialysis who received KT between 2000 and 2010 at United States transplant centers. We linked Medicare data to United Network for Organ Sharing data and data from a national dialysis provider to examine pre-KT (1) Elixhauser Comorbidity Index, (2) physical function (PF) measured by the Short Form 36 Health Survey, and (3) the number of hospitalizations during the 12 months before KT as potential predictors of early rehospitalization after KT. We also explored whether these metrics are confounders of the known association between early rehospitalization and post-transplant mortality. The median age was 52 years (interquartile range [IQR] 41, 60) and 63% were male. 29% were rehospitalized in <30 days, and 20% died during a median follow-up time of five years (IQR 3.6–6.5). In a multivariable logistic model, kidney recipients with more pre-KT Elixhauser comorbidities (adjusted odds ratio [aOR] 1.09 per comorbidity, 95% Confidence Interval [CI] 1.07–1.11), the poorest pre-KT PF (aOR 1.24, 95% CI 1.08–1.43), or >1 pre-KT hospitalizations (aOR 1.32, 95% CI 1.17–1.49) were more likely to be rehospitalized. All three health status metrics and early rehospitalization were independently associated with post-KT mortality in a multivariable Cox model (adjusted hazard ratio for rehospitalization: 1.41, 95% CI 1.28–1.56) Pre-transplant metrics of health status, measured by dialysis providers or administrative data, are independently associated with early rehospitalization and mortality risk after KT. Transplant providers may consider utilizing metrics of pre-KT global health status as early signals of vulnerability when transitioning care after KT.