Grosso G, Corona D, Mistretta A, Zerbo D, Sinagra N, Giaquinta A, Tallarita T, Ekser B, Leonardi A, Gula R, Veroux P, Veroux M
Department G.F. Ingrassia, Section of Hygiene and Public Health, University Hospital of Catania, Catania, Italy.
Transplant Proc. 2012 Sep;44(7):1859-63. doi: 10.1016/j.transproceed.2012.06.042.
Nonimmunologic factors have been recently implicated in worse outcomes after kidney transplantation, producing a need to predict the operative risk among kidney recipients. We assessed the predictive value of the Charlson comorbidity index (CCI) among kidney transplant recipients.
A retrospective study of 223 first deceased-donor kidney transplantations performed from 2000 to 2007 evaluated the role of comorbidities.
About 50% of recipients displayed >1 comorbid condition before transplantation; the most frequently reported was diabetes mellitus. Increasing CCI scores significantly affected graft and patient survivals. Crude analysis showed a significant association between CCI >1 and risk of death (hazard ratio [HR], 3.87; 95% confidence interval [CI], 1.06-14.06; P = .04). After adjustment for several covariates, high CCI values remained significantly predictive of posttransplantation outcomes with a HR for death of (12.53; 95% CI, 1.9-82.68; P = .009).
Our predictive model showed a strong association of CCI and patient survival even after adjustment for several clinical covariates. CCI may be used to evaluate patients referred for kidney transplantation who display a significant burden of comorbid conditions that increase the risk of premature death or graft loss.
非免疫因素最近被认为与肾移植后较差的预后有关，这就需要预测肾移植受者的手术风险。我们评估了Charlson合并症指数（CCI）在肾移植受者中的预测价值。
一项对2000年至2007年进行的223例首次尸体供肾移植的回顾性研究评估了合并症的作用。
约50%的受者在移植前存在>1种合并症；最常报告的是糖尿病。CCI评分的增加显著影响移植物和患者的存活率。粗分析显示CCI>1与死亡风险之间存在显著关联（风险比[HR]，3.87；95%置信区间[CI]，1.06 - 14.06；P = 0.04）。在对多个协变量进行调整后，高CCI值仍然显著预测移植后的结局，死亡的HR为（12.53；95%CI，1.9 - 82.68；P = 0.009）。
我们的预测模型显示，即使在对多个临床协变量进行调整后，CCI与患者存活率之间仍有很强的关联。CCI可用于评估因合并症负担较重而增加过早死亡或移植物丢失风险的肾移植转诊患者。
