The Stanford Integrated Psychosocial Assessment for Transplantation: A Prospective Study of Medical and Psychosocial Outcomes
The Stanford Integrated Psychosocial Assessment for Transplantation: A Prospective Study of Medical and Psychosocial Outcomes
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斯坦福移植综合社会心理评估： 医疗和社会心理结果的前瞻性研究
DOI：
10.1097/psy.0000000000000241
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发表时间：
2015-11-01
影响因子：
3.3
通讯作者：
Standridge, Kim
中科院分区：
文献类型：
--
作者：
Maldonado, Jose R.;Sher, Yelizaveta;Standridge, Kim
心理社会因素可能会显著影响移植后的结果。斯坦福大学综合心理社会评估移植（SIPAT）开发的评估工具，以提高移植前的心理社会evaluation.Methods，我们确定了心脏，肺，肝，肾移植受者评估与SIPAT移植前和移植之间的2008年6月1日，2011年7月31日，在我们的机构。我们前瞻性地分析了累积的心理社会和医疗结果，在1年的following.Results 217例患者被确定并纳入分析。器官衰竭和死亡的主要结局分别发生在12例和21例患者中，与移植前SIPAT评分无显著相关性。另一方面，SIPAT评分与不良医疗和心理社会结局（次要结局）的概率显著相关。事实上，SIPAT分数越高，排斥反应发生率越高（斯皮尔曼= 0.15，95%和95%置信区间[CI] = 0.02-0.28，p = 0.023），医疗住院（= 0.29，95% CI = 0.16-0.41，p < .001），感染率（p = 0.020）、精神失代偿（p = 0.005）和支持系统衰竭（曲线下面积= 0.70，95%CI = 0.60-0.79，p <0.001）。与不依从性的关系表明了一种趋势，但未观察到统计学显著性（曲线下面积= 0.60，95% CI = 0.50-0.71，结论研究结果表明，SIPAT是一种有前途的预-移植评估工具，有助于确定候选人的心理脆弱领域，其得分与移植后的心理和医疗结果相关。移植
Background Psychosocial factors may significantly affect post-transplant outcomes. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) was developed as an assessment tool to enhance the pre-transplant psychosocial evaluation.Methods We identified heart, lung, liver, or kidney transplant recipients assessed with the SIPAT pre-transplantation and transplanted between June 1, 2008, and July 31, 2011, at our institution. We analyzed prospectively accumulated psychosocial and medical outcomes at 1 year of follow-up.Results 217 patients were identified and included in the analysis. The primary outcomes of organ failure and mortality occurred in 12 and 21 patients, respectively, and were not significantly associated with the pre-transplant SIPAT scores. On the other hand, SIPAT scores were significantly correlated with the probability of poor medical and psychosocial outcomes (secondary outcomes). In fact, higher SIPAT scores predicted higher rates of rejection episodes (Spearman = 0.15, 95% 95% confidence interval [CI] = 0.02-0.28, p = .023), medical hospitalizations ( = 0.29, 95% CI = 0.16-0.41, p < .001), infection rates (p = .020), psychiatric decompensation (p = .005), and support system failure (area under the curve = 0.70, 95% CI = 0.60-0.79, p < .001). The relationship with nonadherence suggested a trend, but no statistical significance was observed (area under the curve = 0.60, 95% CI = 0.50-0.71, p = .058).Conclusions Study outcomes suggest that SIPAT is a promising pre-transplantation assessment tool that helps identify candidate's areas of psychosocial vulnerability and whose scores are associated with both psychosocial and medical outcomes after transplantation.