Key Comorbid Conditions that Are Predictive of Survival among Hemodialysis Patients
Key Comorbid Conditions that Are Predictive of Survival among Hemodialysis Patients
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DOI：
10.2215/cjn.00640109
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发表时间：
2009-11-01
影响因子：
9.8
通讯作者：
Port, Friedrich K.
中科院分区：
文献类型：
--
作者：
Miskulin, Dana;Bragg-Gresham, Jennifer;Port, Friedrich K.
背景和目标：从医疗记录中提取有关共病的信息可能很耗时，特别是当考虑大量条件时。我们试图确定哪些条件是最预后和合并症是否继续有助于生存模型，一旦实验室和临床参数已accountedfor.Design，设置，参与者，和测量：合并症数据是从透析结果和实践模式研究（DOPPS）的医疗记录中提取的I，II，III参与者使用标准化问卷。共病条件和病例组合因素的不同组合组成的模型进行了比较，解释方差W）和歧视（c统计量）。结果：17个共病条件占96%的总解释方差，将导致如果45个共病，预计是预测生存被添加到人口统计学调整的生存模型。这些条件加在一起比单独的年龄（0.63）或血清白蛋白（0.60）具有更大的区分能力（c统计量0.67），相当于常规实验室和临床参数的组合（0.67）。当增加实验室/临床参数时，个体合并症的相关性强度降低，但所有合并症均保持显著性。调整人口统计学和实验室/临床参数的模型的总R-2从0.13增加到0.17后，除了comorrhiza.Conclusions：一个相对较小的列表共病条件提供了同等的歧视和解释方差生存作为一个更广泛的特征的comorrhiza。合并症给生存模型增加了少量的独立预后信息，这些信息不能被临床/实验室参数替代。Clin J Am Soc Nephrol 4：1818-1826，2009. doi：10.2215/CJN.00640109
Background and objectives: Abstracting information about comorbid illnesses from the medical record can be time-consuming, particularly when a large number of conditions are under consideration. We sought to determine which conditions are most prognostic and whether comorbidity continues to contribute to a survival model once laboratory and clinical parameters have been accounted for.Design, setting, participants, & measurements: Comorbidity data were abstracted from the medical records of Dialysis Outcomes and Practice Pattern Study (DOPPS) I, II, and III participants using a standardized questionnaire. Models that were composed of different combinations of comorbid conditions and case-mix factors were compared for explained variance W) and discrimination (c statistic).Results: Seventeen comorbid conditions account for 96% of the total explained variance that would result if 45 comorbidities that were expected to be predictive of survival were added to a demographics-adjusted survival model. These conditions together had more discriminatory power (c statistic 0.67) than age alone (0.63) or serum albumin (0.60) and were equivalent to a combination of routine laboratory and clinical parameters (0.67). The strength of association of the individual comorbidities lessened when laboratory/clinical parameters were added, but all remained significant. The total R-2 of a model adjusted for demographics and laboratory/clinical parameters increased from 0.13 to 0.17 upon addition of comorbidity.Conclusions: A relatively small list of comorbid conditions provides equivalent discrimination and explained variance for survival as a more extensive characterization of comorbidity. Comorbidity adds to the survival model a modest amount of independent prognostic information that cannot be substituted by clinical/laboratory parameters. Clin J Am Soc Nephrol 4: 1818-1826, 2009. doi: 10.2215/CJN.00640109