Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, PR China.
Perit Dial Int. 2013 Jan-Feb;33(1):60-6. doi: 10.3747/pdi.2011.00204. Epub 2012 Aug 1.
Studies in hemodialysis patients suggest that the "surprise" question can help to identify a group of patients with a high mortality risk who should receive priority for palliative care interventions. However, the same instrument has not been tested in peritoneal dialysis (PD) patients.
We studied 367 prevalent PD patients from a single dialysis center. Three clinicians independently answered the "surprise" question (Would I be surprised if this patient died within the next 12 months?) according to their clinical impression of the individual patient. Patients are then classified into "yes" (yes, surprised) and "no" (no, not surprised) groups. All patients were followed for 12 months.
In this cohort, 109 patients (29.7%) were allocated to the "no" group, and 258 (70.3%), to the "yes" group. Patients in the "no" group were older and had high prevalences of pre-existing ischemic heart disease, cerebrovascular disease, and peripheral vascular disease. The "no" group had a higher score on the Charlson comorbidity index and a higher malnutrition-inflammation score. At 12 months, 44 patients had died. Mortality was 24.8% in the "no" group and 6.6% in the "yes" group. Multivariate analysis showed that an opinion of "Not surprised if dies in the next 12 months" was an independent predictor of 12-month mortality, with an associated 3.594 excess mortality risk (95% confidence interval: 1.411 to 9.151; p = 0.007). The positive predictive value of this opinion was 24.8%, and its negative predictive value was 93.4%.
The "surprise" question has the potential to help identify a group of PD patients with high short-term mortality. Its use may contribute to a decision to refer PD patients for early palliative care assessment.
在血液透析患者中的研究表明，“意外”问题可以帮助识别出一组死亡率较高的患者，这些患者应优先接受姑息治疗干预。然而，同样的工具尚未在腹膜透析（PD）患者中进行测试。
我们研究了来自单一透析中心的 367 名现患 PD 患者。三位临床医生根据他们对个体患者的临床印象，独立回答“意外”问题（如果这位患者在未来 12 个月内死亡，我会感到惊讶吗？）。然后，患者被分为“是”（惊讶）和“否”（不惊讶）组。所有患者均随访 12 个月。
在该队列中，有 109 名患者（29.7%）被分配到“否”组，258 名（70.3%）分到“是”组。“否”组患者年龄较大，且既往存在缺血性心脏病、脑血管病和外周血管疾病的患病率较高。“否”组患者的 Charlson 合并症指数评分较高，营养不良-炎症评分也较高。在 12 个月时，有 44 名患者死亡。“否”组的死亡率为 24.8%，“是”组为 6.6%。多变量分析显示，认为“如果在未来 12 个月内死亡，不会感到惊讶”是 12 个月死亡率的独立预测因素，相关的超额死亡风险为 3.594（95%置信区间：1.411 至 9.151；p = 0.007）。该意见的阳性预测值为 24.8%，阴性预测值为 93.4%。
“意外”问题有可能帮助识别出一组短期死亡率较高的 PD 患者。它的使用可能有助于决定将 PD 患者转介进行早期姑息治疗评估。
