Additional prognostic value of toe-brachial index beyond ankle-brachial index in hemodialysis patients
Additional prognostic value of toe-brachial index beyond ankle-brachial index in hemodialysis patients
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DOI：
10.1186/s12882-020-01991-7
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发表时间：
2020-08-20
期刊：
影响因子：
2.3
通讯作者：
Matsushita, Kunihiro
中科院分区：
文献类型：
--
作者：
Hishida, Manabu;Imaizumi, Takahiro;Matsushita, Kunihiro
踝臂指数（ABI）是外周动脉疾病的一线诊断指标，当踝动脉不可压缩时，ABI可能假性升高，与死亡率呈J形相关。在这种情况下，脚趾肱指数（TBI）是推荐的测试。然而，TBI是否提供了额外的预后信息以外的ABI在血液透析patients.MethodsIn这项回顾性队列研究的247例日本流行的血液透析患者（平均年龄66.8 [SD 11.6]岁），我们评估了死亡率（中位随访时间为5.2年，116例死亡）与ABI和TBI的四分位数相关，以及三种低ABI（0.9）+低TBI结果ABI与死亡率呈J型相关（最低四分位数的校正风险比为2.72 [95% CI，1.52-4.88]，最高四分位数为1.59 [95% CI，0.87-2.90]，第二高）。较低的TBI显示出与死亡率的潜在剂量反应相关性（例如，最低两个四分位数与最高四分位数的校正风险比分别为2.63 [95% CI，1.36-5.12]和2.89 [95% CI，1.49-5.61]）。当分析ABI和TBI的三个类别时，（0.9）+低TBI（0.9），低TBI个体的死亡风险增加（0.6）具有显著性（调整后的风险比1.84 [95% CI，1.12-3.02]）结论低TBI与血液透析患者的死亡率独立相关，并有可能将死亡风险分类为正常/高ABI患者。我们的研究结果支持在这个临床人群中除了ABI之外评估TBI的重要性。
BackgroundAnkle-brachial index (ABI), the first-line diagnostic test for peripheral artery disease, can be falsely elevated when ankle arteries are incompressible, showing a J-shaped association with mortality. In this situation, toe-brachial index (TBI) is the recommended test. However, whether TBI provides additional prognostic information beyond ABI in patients on hemodialysis is unknown.MethodsIn this retrospective cohort study of 247 Japanese prevalent hemodialysis patients (mean age 66.8 [SD 11.6] years), we evaluated mortality (116 deaths over a median follow-up of 5.2years) related to quartiles of ABI and TBI, as well as three categories of low ABI (0.9)+low TBI (0.6) using multivariable Cox models.ResultsABI showed a J-shaped association with mortality (adjusted hazard ratio 2.72 [95% CI, 1.52-4.88] in the lowest quartile and 1.59 [95% CI, 0.87-2.90] in the highest quartile vs. the second highest). Lower TBI showed a potentially dose-response association with mortality (e.g., adjusted hazard ratios 2.63 [95% CI, 1.36-5.12] and 2.89 [95% CI, 1.49-5.61] in the lowest two quartiles vs. the highest). When three categories by both ABI and TBI were analyzed, those with low ABI (0.9)+low TBI (0.9), the increased mortality risk in individuals with low TBI (0.6) were significant (adjusted hazard ratio 1.84 [95% CI, 1.12-3.02]).ConclusionsLower TBI was independently associated with mortality in patients on hemodialysis and has the potential to classify mortality risk in patients with normal/high ABI. Our results support the importance of evaluating TBI in addition to ABI in this clinical population.