The choice of comorbidity scoring system in Chinese peritoneal dialysis patients
The choice of comorbidity scoring system in Chinese peritoneal dialysis patients
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DOI：
10.1007/s10157-017-1418-5
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发表时间：
2018-02-01
影响因子：
2.3
通讯作者：
Szeto, Cheuk Chun
中科院分区：
文献类型：
--
作者：
Ma, Terry King-Wing;Chow, Kai Ming;Szeto, Cheuk Chun
已经开发并验证了几种合并症评分系统，主要用于心血管疾病高风险的西方血液透析患者。然而，合并症评分的表现取决于患者人群。在本研究中，我们确定了最佳的合并症评分系统，用于预测中国PD患者的生存率。比较了Charlson合并症指数（CCI）、Hemmelgarn评分和Liu评分作为生存预测因子的性能，平均年龄为57.7 ± 13.7岁。中位CCI、Hemmelgarn和Liu评分分别为4 [四分位距（IQR）2-5]、1（IQR 0-2）和4（IQR 2-5）。患者随访45.5 ± 33.0个月。通过单变量分析，所有3种共病评分均为患者生存的预测因子。校正混杂因素后，CCI是3个指数中患者生存率的最佳预测因子，CCI每增加一点，死亡风险增加31%[95%置信区间（CI）21- 41%，p < 0.001]。相反，Liu评分每增加一分，死亡风险增加20%（95% CI 13- 27%，p < 0.001）。虽然Hemmelgarn评分是患者生存的独立预测因子，但超过70%的患者评分为0或1，限制了其作为预后标志物的作用。CCI应该是量化中国PD患者并发症负荷的首选方法，并且它是这组患者生存的良好预测因子。
Several comorbidity scoring systems have been developed and validated, mostly in western hemodialysis patients with a high risk of cardiovascular disease. The performance of comorbidity scoring, however, depends on the patient population. In this study, we determine the optimal comorbidity scoring system for predicting survival of incident Chinese PD patients.We studied 461 incident PD patients. The performance of Charlson Comorbidity Index (CCI), Hemmelgarn score, and Liu score as the survival predictor was compared.The mean age was 57.7 +/- 13.7 years. The median CCI, Hemmelgarn, and Liu scores were 4 [inter-quartile range (IQR) 2-5], 1 (IQR 0-2), and 4 (IQR 2-5), respectively. Patients were followed for 45.5 +/- 33.0 months. All 3 comorbidity scores were predictors of patient survival by univariate analysis. After adjusting for confounding factors, CCI was the best predictor of patient survival among the 3 indices, with each point increase in CCI conferring 31% excess in mortality risk [95% confidence interval (CI) 21-41%, p < 0.001]. In contrast, each point increase in Liu score confers 20% excess in mortality risk (95% CI 13-27%, p < 0.001). Although the Hemmelgarn score is an independent predictor of patient survival, over 70% of patients score 0 or 1 by this system, limiting its role as a prognostic marker.CCI should be the preferred method for quantifying comorbidity load in incident Chinese PD patients, and it is a good predictor of survival in this group of patients.