Thong Melissa S Y, Kaptein Adrian A, Benyamini Yael, Krediet Raymond T, Boeschoten Elisabeth W, Dekker Friedo W
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Am J Kidney Dis. 2008 Jul;52(1):111-7. doi: 10.1053/j.ajkd.2008.04.001. Epub 2008 May 29.
Self-rated health (SRH) has been shown to predict mortality in large community-based studies; however, large clinical-based studies of this topic are rare. We assessed whether an SRH item predicts mortality in a large sample of incident dialysis patients beyond sociodemographic, disease, and clinical measures and possible age interaction.
Prospective cohort study.
SETTING & PARTICIPANTS: 1,443 predominantly white patients from 38 dialysis centers in The Netherlands participating in the Netherlands Cooperative Study on the Adequacy of Dialysis-2 between 1997 and 2004.
SRH score completed at 3 months after the start of dialysis therapy (baseline).
OUTCOMES & MEASUREMENTS: Cox proportional hazards model estimated the association between SRH and all-cause mortality. Interaction of SRH with age (<65 and >/=65 years) was examined in an additive model.
Mean age of patients was 59.6 +/- 14.8 years, with 61% men and 69% married/living together. Mean follow-up was 2.7 +/- 1.8 years. Deaths per SRH group in the multivariate analyses sample: excellent/very good (9 of 63 patients; 14.3%), good (148 of 473 patients; 31.3%), fair (194 of 508 patients; 38.2%), and poor (45 of 71 patients; 63.4%). Patients with poor, fair, or good health ratings had a greater mortality risk than those with excellent/very good health ratings (adjusted hazard ratio [HR(adj)], 3.56; 95% confidence interval [CI], 1.71 to 7.42; HR(adj), 2.09; 95% CI, 1.06 to 4.12; HR(adj), 1.87; 95% CI, 0.95 to 3.70, respectively) independent of a range of risk factors. No age interaction with SRH was found.
Although the SRH-mortality association remained strong despite extensive adjustments, unknown residual confounding could still exist.
SRH is an independent predictor of mortality in incident dialysis patients. Patients with poor SRH in both age strata had a significantly increased risk of mortality even after controlling for demographic and clinical confounders. Patient self-assessment of health can be an invaluable and economical complement to clinical measures in risk assessment.
在大规模基于社区的研究中，自评健康状况（SRH）已被证明可以预测死亡率；然而，关于这一主题的大规模基于临床的研究却很少见。我们评估了在一个大型的新发透析患者样本中，除社会人口统计学、疾病和临床指标以及可能的年龄交互作用外，一个SRH项目是否能预测死亡率。
前瞻性队列研究。
1997年至2004年间，来自荷兰38个透析中心的1443名主要为白人的患者参与了荷兰透析充分性合作研究-2。
透析治疗开始后3个月（基线）完成的SRH评分。
Cox比例风险模型估计了SRH与全因死亡率之间的关联。在一个相加模型中检验了SRH与年龄（<65岁和≥65岁）的交互作用。
患者的平均年龄为59.6±14.8岁，男性占61%，已婚/同居者占69%。平均随访时间为2.7±1.8年。多变量分析样本中每个SRH组的死亡人数：优秀/非常好（63名患者中有9名；14.3%），良好（473名患者中有148名；31.3%），中等（508名患者中有194名；38.2%），差（71名患者中有45名；63.4%）。健康评级为差、中等或良好的患者比健康评级为优秀/非常好的患者有更高的死亡风险（校正风险比[HR(adj)]，3.56；95%置信区间[CI]，1.71至7.42；HR(adj)，2.09；95%CI，1.06至4.12；HR(adj)，1.87；95%CI，0.95至3.70），且不受一系列风险因素的影响。未发现SRH与年龄的交互作用。
尽管经过广泛调整后SRH与死亡率的关联仍然很强，但仍可能存在未知的残余混杂因素。
SRH是新发透析患者死亡率的独立预测因素。即使在控制了人口统计学和临床混杂因素后，两个年龄组中SRH较差的患者死亡率风险仍显著增加。患者的健康自评在风险评估中可以成为临床测量的一种非常有价值且经济的补充。
