Miskulin Dana C, Meyer Klemens B, Martin Alice A, Fink Nancy E, Coresh Josef, Powe Neil R, Klag Michael J, Levey Andrew S
Division of Nephrology, Tufts-New England Medical Center, Boston, MA 02111, USA.
Am J Kidney Dis. 2003 Jan;41(1):149-61. doi: 10.1053/ajkd.2003.50034.
Few studies have performed a comprehensive comparison of the prognostic importance of comorbidity to that of other case-mix factors influencing incident dialysis patients' survival. Longitudinal change in the comorbid illness burden of incident dialysis patients has not been measured. Comorbidity severity and its change may serve as important prognostic markers of survival, independent of other case-mix factors.
The Choices for Healthy Outcomes in Caring for End-Stage Renal Disease Cohort Study used the Index of Coexistent Disease (ICED) to assess comorbidity at the initiation of chronic dialysis treatment (1,039 incident patients) and during follow-up (733 patients). Using proportional hazards regression analyses, the relationship to survival of baseline ICED level and change in ICED level was examined.
At the initiation of chronic dialysis treatment, 36% of patients were at ICED level 0 to 1 (least comorbidity severity); 35%, level 2; and 29%, level 3. After multivariable adjustment, baseline ICED level was the strongest predictor of subsequent mortality. Compared with ICED level 0 to 1, relative risks for mortality were 1.9 (95% confidence interval, 1.3 to 2.6) for ICED level 2 and 2.8 (95% confidence interval, 2.0 to 3.9) for ICED level 3. The prevalence and severity of most comorbid conditions increased during follow-up. After controlling for baseline ICED level and other factors, change in ICED level over time was significantly associated with mortality (P = 0.01).
Indexing comorbidity when patients begin chronic dialysis therapy and recording the evolution of index scores yields a predictor of mortality risk that is independent of other case-mix factors.
很少有研究对合并症与影响新发透析患者生存的其他病例组合因素的预后重要性进行全面比较。尚未对新发透析患者合并疾病负担的纵向变化进行测量。合并症严重程度及其变化可能是生存的重要预后标志物，独立于其他病例组合因素。
“终末期肾病队列研究中健康结局的选择”使用共存疾病指数（ICED）来评估慢性透析治疗开始时（1039例新发患者）和随访期间（733例患者）的合并症情况。使用比例风险回归分析，研究基线ICED水平和ICED水平变化与生存的关系。
在慢性透析治疗开始时，36%的患者ICED水平为0至1（合并症严重程度最低）；35%为2级；29%为3级。多变量调整后，基线ICED水平是随后死亡率的最强预测因素。与ICED水平0至1相比，ICED水平2的死亡相对风险为1.9（95%置信区间，1.3至2.6），ICED水平3的死亡相对风险为2.8（95%置信区间，2.0至3.9）。大多数合并症的患病率和严重程度在随访期间增加。在控制了基线ICED水平和其他因素后，ICED水平随时间的变化与死亡率显著相关（P = 0.01）。
在患者开始慢性透析治疗时对合并症进行索引并记录索引分数的演变可得出一个独立于其他病例组合因素的死亡风险预测指标。
