Prediction of early death in end-stage renal disease patients starting dialysis
Prediction of early death in end-stage renal disease patients starting dialysis
复制标题
DOI：
10.1016/s0272-6386(97)90032-9
复制
发表时间：
1997-02-01
影响因子：
13.2
通讯作者：
Richardson, RMA
中科院分区：
文献类型：
--
作者：
Barrett, BJ;Parfrey, PS;Richardson, RMA
终末期肾病患者对透析的需求不断增长，透析患者的合并症也在不断增长。准确预测那些尽管接受透析但注定会很快死亡的人可能有助于患者、提供者和社会做出开始透析的决定。为了确定年龄和合并症是否能准确预测终末期肾病首次透析后 6 个月内的死亡，对在 11 个加拿大中心之一开始透析的 822 名患者进行了一项前瞻性队列研究。第一次透析时记录患者特征。随访持续至死亡或研究结束（入组后至少 6 个月）。 822 名患者中有 113 名（13.7%）在 6 个月内死亡。尽管现有的评分系统可以预测预后，但只有 9.7% 的死亡者的不良评分大于 9；得分高于 9 的人中，只有 52% 在 6 个月内死亡。无评分截止点结合了高真阳性率和低假阳性率来预测早期死亡。年龄、心力衰竭或周围血管疾病的严重程度、心律失常、营养不良、恶性肿瘤或骨髓瘤是多变量模型中确定的独立预后因素。然而，最适合的判别模型和逻辑模型也无法准确预测 6 个月内的死亡情况。临床医生非常准确地将患者分配到 6 个月内死亡风险高达 50% 的预后组，高于该风险时他们往往会高估风险。然而，在确定特定高风险患者是否会死亡方面，临床医生仅比预测模型稍好一些。评分系统或临床直觉无法在终末期肾病开始透析后不久准确预测死亡，这表明在加拿大，基于可能较短的生存期来限制透析的机会可能是不合适的。 (C) 1997 年，国家肾脏基金会 (National Kidney Foundation, Inc.)
Demand for dialysis for patients with end-stage renal disease is growing, as is the comorbidity of dialysis patients. Accurate prediction of those destined to die quickly despite dialysis could be useful to patients, providers, and society in making decisions about starting dialysis. To determine whether age and comorbidity accurately predict death within 6 months of first dialysis for end-stage renal disease, a prospective cohort study of 822 patients starting dialysis at one of 11 Canadian centers was performed. Patient characteristics were recorded at first dialysis. Follow-up continued until death or study end (at least 6 months after enrollment). One hundred thirteen of 822 (13.7%) patients died within 6 months. Although an existing scoring system predicted prognosis, adverse scores greater than 9 were found in only 9.7% of those who died; only 52% of those who scored higher than 9 died within 6 months. No score cutoff point combined high true-positive and low false-positive rates for predicting early death. Age, severity of heart failure or peripheral vascular disease, arrhythmias, malnutrition, malignancy, or myeloma were independent prognostic factors identified in multivariate models. However, the best fit discriminant and logistic models were also unable to accurately predict death within 6 months. Clinicians were very accurate in assigning patients to prognostic groups up to a 50% risk of death by 6 months, above which they tended to overestimate risk. However, clinicians were only marginally better than the predictive models in determining whether a given high-risk patient would die. The inability of a scoring system or clinical intuition to accurately predict death soon after starting dialysis for end-stage renal disease suggests that limiting access to dialysis on the basis of likely short survival may be inappropriate in Canada. (C) 1997 by the National Kidney Foundation, Inc.