Johnson Miriam J, Bland J Martin, Davidson Patricia M, Newton Phillip J, Oxberry Stephen G, Abernethy Amy P, Currow David C
Palliative Medicine, Hull York Medical School, University of Hull, Hull, United Kingdom.
Department of Health Sciences, University of York, Heslington, York, United Kingdom.
J Pain Symptom Manage. 2014 Mar;47(3):652-8. doi: 10.1016/j.jpainsymman.2013.05.006. Epub 2013 Jul 30.
Performance status is used to quantify the well-being and functional status of people with illness. Clinicians and researchers from differing fields may not instinctively understand the scales, typically disease specific, used in other disciplines.
To provide a preliminary description of the relationship between the Karnofsky Performance Status Scale (KPS) and the New York Heart Association Classification (NYHA) and to stimulate discussion in research and clinical practice.
Simultaneous KPS and NYHA data (172 observations) from three studies of people with chronic heart failure were pooled. Linear regression was used to predict the mean KPS from NYHA. The strength of association between the scales was investigated using a Kendall's Tau-b correlation coefficient. The agreement between the predicted and observed KPS scores was investigated using weighted kappa with quadratic weights.
Linear regression demonstrated a relationship between KPS and NYHA (P < 0.0001; R(2) = 0.3). Predicted KPS from NYHA class rounded to the nearest 10 gave the following values: Class I, predicted KPS 90%; Class II, predicted KPS 80%; Class III, predicted KPS 70%; and Class IV, predicted KPS 60%. A moderate strength of association between KPS and NYHA (Kendall's Tau-b correlation coefficient of -0.49; P < 0.0001) and agreement between observed and predicted KPS (kappa coefficient = 0.52) was shown.
We suggest that the NYHA discriminates poorly between clinically important performance states in people with advanced disease (NYHA III and IV; KPS <50%). The KPS, used in conjunction, would provide useful additional information in research and clinical practice.
体能状态用于量化患病者的健康状况和功能状态。来自不同领域的临床医生和研究人员可能不会本能地理解其他学科中使用的量表，这些量表通常是针对特定疾病的。
初步描述卡诺夫斯基体能状态量表（KPS）与纽约心脏协会心功能分级（NYHA）之间的关系，并促进研究和临床实践中的讨论。
汇总了三项慢性心力衰竭患者研究中的KPS和NYHA同步数据（172例观察结果）。使用线性回归从NYHA预测平均KPS。使用肯德尔tau-b相关系数研究量表之间的关联强度。使用二次权重的加权kappa研究预测的和观察到的KPS分数之间的一致性。
线性回归显示KPS与NYHA之间存在关系（P < 0.0001；R² = 0.3）。根据NYHA分级预测的KPS四舍五入到最接近的10得到以下值：I级，预测KPS 90%；II级，预测KPS 80%；III级，预测KPS 70%；IV级，预测KPS 60%。显示KPS与NYHA之间存在中等强度的关联（肯德尔tau-b相关系数为-0.49；P < 0.0001），并且观察到的和预测的KPS之间具有一致性（kappa系数 = 0.52）。
我们认为NYHA在区分晚期疾病患者（NYHA III级和IV级；KPS < 50%）临床上重要的体能状态方面表现不佳。联合使用KPS将在研究和临床实践中提供有用的额外信息。
