步行障碍问卷可改善高危队列中死亡风险预测模型，且独立于外周动脉疾病状态。
Walking impairment questionnaire improves mortality risk prediction models in a high-risk cohort independent of peripheral arterial disease status.
作者信息
Nead Kevin T, Zhou Margaret, Diaz Caceres Roxanne, Olin Jeffrey W, Cooke John P, Leeper Nicholas J
机构信息
Division of Cardiovascular Medicine and Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA.
出版信息
Circ Cardiovasc Qual Outcomes. 2013 May 1;6(3):255-61. doi: 10.1161/CIRCOUTCOMES.111.000070. Epub 2013 Apr 30.
BACKGROUND
The Walking Impairment Questionnaire (WIQ) is a subjective measure of patient-reported walking performance developed for peripheral arterial disease. The purpose of this study is to examine whether this simple tool can improve the predictive capacity of established risk models and whether the WIQ can be used in patients without peripheral arterial disease.
METHODS AND RESULTS
At baseline we assessed the walking distance, stair-climbing, and walking speed WIQ category scores among individuals who were undergoing coronary angiography. During a median follow-up of 5.0 years, there were 172 mortalities among 1417 study participants. Adjusted Cox proportional hazards models showed that all 3 WIQ categories independently predicted future all-cause and cardiovascular mortality, including among individuals without peripheral arterial disease (P<0.001). Compared with the cardiovascular risk factors model, we observed significantly increased risk discrimination with a C-index of 0.741 (change in C-index, 0.040; 95% confidence interval, 0.011-0.068) and 0.832 (change in C-index, 0.080; 95% confidence interval, 0.034-0.126) for all-cause and cardiovascular mortality, respectively. Examination of risk reclassification using the net reclassification improvement index showed a 48.4% (P<0.001) improvement for all-cause mortality and a 77.4% (P<0.001) improvement for cardiovascular mortality compared with the cardiovascular risk factors model.
CONCLUSIONS
All 3 WIQ categories independently predicted future all-cause and cardiovascular mortality. Importantly, we found that this subjective measure of walking ability could be extended to patients without peripheral arterial disease. The addition of the WIQ scores to established cardiovascular risk models significantly improved risk discrimination and reclassification, suggesting broad clinical use for this simple, inexpensive test.
背景
步行障碍问卷（WIQ）是一种针对外周动脉疾病开发的、用于患者自我报告步行能力的主观测量方法。本研究旨在探讨这一简单工具能否提高既定风险模型的预测能力，以及WIQ是否可用于无外周动脉疾病的患者。
方法与结果
在基线时，我们评估了接受冠状动脉造影的个体的步行距离、爬楼梯能力以及步行速度的WIQ类别得分。在中位随访5.0年期间，1417名研究参与者中有172人死亡。调整后的Cox比例风险模型显示，所有3个WIQ类别均能独立预测未来全因死亡率和心血管死亡率，包括无外周动脉疾病的个体（P<0.001）。与心血管危险因素模型相比，我们观察到全因死亡率和心血管死亡率的风险辨别能力显著提高，C指数分别为0.741（C指数变化，0.040；95%置信区间，0.011 - 0.068）和0.832（C指数变化，0.080；95%置信区间，0.034 - 0.126）。使用净重新分类改善指数进行风险重新分类检查显示，与心血管危险因素模型相比，全因死亡率改善了48.4%（P<0.001），心血管死亡率改善了77.4%（P<0.001）。
结论
所有3个WIQ类别均能独立预测未来全因死亡率和心血管死亡率。重要的是，我们发现这种步行能力的主观测量方法可扩展到无外周动脉疾病的患者。将WIQ得分添加到既定的心血管风险模型中可显著改善风险辨别和重新分类，表明这种简单、廉价的测试具有广泛的临床应用价值。
Zotero 插件