A comparison of systemic inflammation-based prognostic scores in patients on regular hemodialysis.
A comparison of systemic inflammation-based prognostic scores in patients on regular hemodialysis.
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作者：
Kato A;Tsuji T;Sakao Y;Ohashi N;Yasuda H;Fujimoto T;Takita T;Furuhashi M;Kumagai H
基于全身炎症的预后评分在癌症患者中具有预后能力，与肿瘤分期和部位无关。虽然炎症状态与血液透析（HD）患者的死亡率相关，但这些综合评分是否可用于预测临床结局仍有待确定。我们计算了6个预后评分[格拉斯哥预后评分（GPS）、改良GPS（mGPS）、嗜中性淋巴细胞比率（NLR）、血小板淋巴细胞比率（PLR）、预后指数（PI）和预后营养指数（PNI）]，这些评分系统已被建立为癌症患者的有用评分系统。我们入组了339例接受常规HD的患者（年龄：64 ± 13岁; HD时间：129 ± 114个月;男性/女性= 253/85），并随访42个月。受试者-操作特征曲线下面积用于确定哪种评分系统更能预测死亡率。GPS、mGPS、NLR、PLR、PI和PNI升高均与总死亡率相关，与协变量无关。如果GPS升高，mGPS、NLR、PLR和PI也可预测全因死亡率和/或住院。GPS和PNI与营养状况不良有关。使用总死亡率作为终点，GPS为0.701（95% CI：0.637 - 0.765; p <0.01）和PNI为0.616（95% CI：0.553 - 0.768; p = 0.01）的曲线下面积（AUC）具有显著性。然而，低白蛋白血症（<3.5 g/dl）的AUC与GPS相当（0.695，95% CI：0.632 - 0.759; p <0.01）。基于血清白蛋白和高敏C-反应蛋白的GPS在HD患者的预后评分中对死亡率预测具有最大的预后能力。然而，由于血清白蛋白的测定反映的死亡率与GPS相似，因此需要其他复合组合来提供HD患者中白蛋白单药治疗以外的额外临床效用。
Systemic inflammation-based prognostic scores have prognostic power in patients with cancer, independently of tumor stage and site. Although inflammatory status is associated with mortality in hemodialysis (HD) patients, it remains to be determined as to whether these composite scores are useful in predicting clinical outcomes. We calculated the 6 prognostic scores [Glasgow prognostic score (GPS), modified GPS (mGPS), neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), prognostic index (PI) and prognostic nutritional index (PNI), which have been established as a useful scoring system in cancer patients. We enrolled 339 patients on regular HD (age: 64 ± 13 years; time on HD: 129 ± 114 months; males/females = 253/85) and followed them for 42 months. The area under the receiver-operating characteristics curve was used to determine which scoring system was more predictive of mortality. Elevated GPS, mGPS, NLR, PLR, PI and PNI were all associated with total mortality, independent of covariates. If GPS was raised, mGPS, NLR, PLR and PI were also predictive of all-cause mortality and/or hospitalization. GPS and PNI were associated with poor nutritional status. Using overall mortality as an endpoint, the area under the curve (AUC) was significant for a GPS of 0.701 (95% CI: 0.637-0.765; p < 0.01) and for a PNI of 0.616 (95% CI: 0.553-0.768; p = 0.01). However, AUC for hypoalbuminemia (<3.5 g/dl) was comparable to that of GPS (0.695, 95% CI: 0.632-0.759; p < 0.01). GPS, based on serum albumin and highly sensitive C-reactive protein, has the most prognostic power for mortality prediction among the prognostic scores in HD patients. However, as the determination of serum albumin reflects mortality similarly to GPS, other composite combinations are needed to provide additional clinical utility beyond that of albumin alone in HD patients.