Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions Baltimore, Maryland, USA.
Ann Thorac Surg. 2012 Mar;93(3):718-24. doi: 10.1016/j.athoracsur.2011.11.054. Epub 2012 Feb 2.
The aim of this study was to evaluate the impact of metabolic risk factors on mortality rates after orthotopic heart transplantation (OHT).
Adult patients undergoing OHT between 1998 and 2008 were identified in the United Network for Organ Sharing registry. The impact of metabolic risk factors (hypertension, diabetes mellitus, and obesity) on mortality post-OHT was evaluated in a Cox proportional hazards regression analysis adjusted for other variables associated with survival in univariate analysis (exploratory p value<0.2). Kaplan-Meier survival estimates were compared with the log-rank test.
A total of 15,960 eligible patients underwent OHT during the study period. There were 6,368 (39.9%) patients with none of these risk factors, 6,138 (38.5%) with 1 risk factor, 2,811 (17.6%) with 2 risk factors, and 643 (4.0%) who had all 3 risk factors. After adjusting for other significant variables influencing survival, each individual risk factor independently increased the likelihood of mortality post-OHT (hypertension: HR 1.10 [1.03 to 1.17]; diabetes: HR 1.22[1.13 to 1.31]; obesity: HR 1.17 [1.10 to 1.26], each p<0.01). There was an exponential trend of increasing mortality with the addition of each risk factor (r2=0.99, p<0.001) such that patients with all 3 risk factors had a 63% increased mortality compared with those with no risk factors (HR 1.63 [1.42 to 1.88], p<0.001). There was also a significant trend in declining 5-year survival rates with an increasing number of risk factors: 0 (74.7%), 1 (71.3%), 2 (68.2%), and 3 (63.1%) (p<0.001).
This large-cohort study demonstrates that an increasing number of metabolic risk factors in OHT recipients is associated with exponential increases in postoperative mortality rates.
本研究旨在评估代谢危险因素对原位心脏移植（OHT）后死亡率的影响。
在美国器官共享网络注册中心确定了 1998 年至 2008 年间接受 OHT 的成年患者。使用 Cox 比例风险回归分析评估代谢危险因素（高血压、糖尿病和肥胖）对 OHT 后死亡率的影响，该分析调整了单变量分析中与生存相关的其他变量（探索性 p 值<0.2）。使用对数秩检验比较 Kaplan-Meier 生存估计值。
在研究期间，共有 15960 名符合条件的患者接受了 OHT。其中 6368 名（39.9%）患者无上述风险因素，6138 名（38.5%）患者有 1 个风险因素，2811 名（17.6%）患者有 2 个风险因素，643 名（4.0%）患者有 3 个风险因素。在调整其他影响生存的重要变量后，每个单独的风险因素都独立增加了 OHT 后死亡的可能性（高血压：HR 1.10[1.03 至 1.17]；糖尿病：HR 1.22[1.13 至 1.31]；肥胖：HR 1.17[1.10 至 1.26]，均<0.01）。随着每个风险因素的增加，死亡率呈指数增长趋势（r2=0.99，<0.001），因此，与无风险因素的患者相比，具有 3 个风险因素的患者死亡率增加了 63%（HR 1.63[1.42 至 1.88]，<0.001）。随着危险因素数量的增加，5 年生存率呈显著下降趋势：0（74.7%）、1（71.3%）、2（68.2%）和 3（63.1%）（<0.001）。
这项大型队列研究表明，OHT 受者的代谢危险因素数量增加与术后死亡率呈指数增长相关。
