Mauri Joan M, Clèries Montse, Vela Emili
Catalan Health Service, Travessera de Les Corts, 131-159, 08021-Barcelona, Spain.
Nephrol Dial Transplant. 2008 May;23(5):1690-6. doi: 10.1093/ndt/gfm728. Epub 2008 Feb 13.
Mortality and morbidity rates are higher in patients receiving haemodialysis therapy than in the general population. Detection of risk factors related to early death in these patients could be of aid for clinical and administrative decision making. Objectives. The aims of this study were (1) to identify risk factors (comorbidity and variables specific to haemodialysis) associated with death in the first year following the start of haemodialysis and (2) to design and validate a prognostic model to quantify the probability of death for each patient.
An analysis was carried out on all patients starting haemodialysis treatment in Catalonia during the period 1997-2003 (n = 5738). The data source was the Renal Registry of Catalonia, a mandatory population registry. Patients were randomly divided into two samples: 60% (n = 3455) of the total were used to develop the prognostic model and the remaining 40% (n = 2283) to validate the model. Logistic regression analysis was used to construct the model.
One-year mortality in the total study population was 16.5%. The predictive model included the following variables: age, sex, primary renal disease, grade of functional autonomy, chronic obstructive pulmonary disease, malignant processes, chronic liver disease, cardiovascular disease, initial vascular access and malnutrition. The analyses showed adequate calibration for both the sample to develop the model and the validation sample (Hosmer-Lemeshow statistic 0.97 and P = 0.49, respectively) as well as adequate discrimination (ROC curve 0.78 in both cases).
Risk factors implicated in mortality at one year following the start of haemodialysis have been determined and a prognostic model designed. The validated, easy-to-apply model quantifies individual patient risk attributable to various factors, some of them amenable to correction by directed interventions.
接受血液透析治疗的患者的死亡率和发病率高于普通人群。检测这些患者早期死亡的相关危险因素有助于临床和管理决策。目的。本研究的目的是：（1）识别血液透析开始后第一年内与死亡相关的危险因素（合并症和血液透析特有的变量）；（2）设计并验证一个预后模型，以量化每位患者的死亡概率。
对1997 - 2003年期间在加泰罗尼亚开始接受血液透析治疗的所有患者（n = 5738）进行分析。数据来源是加泰罗尼亚肾脏登记处，这是一个强制性的人群登记处。患者被随机分为两个样本：总样本的60%（n = 3455）用于建立预后模型，其余40%（n = 2283）用于验证模型。采用逻辑回归分析构建模型。
整个研究人群的一年死亡率为16.5%。预测模型包括以下变量：年龄、性别、原发性肾脏疾病、功能自主程度、慢性阻塞性肺疾病、恶性肿瘤、慢性肝病、心血管疾病、初始血管通路和营养不良。分析表明，建立模型的样本和验证样本均具有良好的校准度（Hosmer-Lemeshow统计量分别为0.97和P = 0.49）以及良好的区分度（两种情况下ROC曲线均为0.78）。
已确定血液透析开始后一年内与死亡相关的危险因素，并设计了一个预后模型。该经过验证且易于应用的模型量化了个体患者因各种因素导致的风险，其中一些因素可通过针对性干预进行纠正。
