Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Eur J Clin Invest. 2014 Feb;44(2):168-75. doi: 10.1111/eci.12203. Epub 2013 Dec 9.
Baseline comorbidities influence patient outcomes in renal transplantation. Identification of high-risk recipients for patient death and early allograft loss might lead to superior stratification.
In this retrospective study, risk stratification models were developed in a cohort of 392 kidney transplant recipients and validated in an independent cohort to predict short-term (2 year) outcomes.
Peripheral arterial disease [OR 7·7 (95% confidence interval (CI): 2·45-24·60); P < 0·001], use of oral anticoagulation [OR 18·68 (95% CI: 3·77-92·46); P < 0·0001], smoking [OR 5·15 (95% CI: 1·67-15·84); P = 0·004], recipient age > 60 years [OR 7·28 (95% CI: 2·33-22·69; P = 0·001)], serum albumin < 40 g/L [OR 5·08 (95% CI: 1·82-14·19); P = 0·002], serum calcium ≥ 2·42 mM [OR 6·47 (95% CI: 1·37-30·58); P = 0·02] living donation [OR 2·95, (95% CI: 0·31-28·29); P = 0·34)] and previous haemodialysis [OR 3·33, (95% CI: 0·39-28·11); P = 0·27)] were included in the model. The validated model discriminated between low- (< 3 points) and high-risk recipients (> 8·5 points) with mortality rates of 0% vs. 54%. The comparison of the model with the Charlson comorbidity index (CCI) yielded significantly better receiver operating characteristic (ROC) areas (Novel Score ROC: 0·87 vs. CCI: 0·72, P = 0·0012). Early allograft loss was associated with presensitization [OR 3·02 (95% CI: 1·29-7·09); P = 0·011] and presence of hepatitis C antibodies [OR 2·42 (95% CI: 1·09-5·34); P = 0·029]. A risk model (ROC: 0·62) for allograft loss could not be developed.
Risk stratification based on the novel score might identify high-risk recipients with disproportional risk of early patient death and lead to optimized strategies.
基线合并症会影响肾移植患者的预后。识别患者死亡和早期移植物丢失的高风险受者可能会导致更好的分层。
在这项回顾性研究中，我们在 392 名肾移植受者队列中开发了风险分层模型，并在独立队列中进行了验证，以预测短期（2 年）结局。
外周动脉疾病[比值比（OR）7.7（95%置信区间（CI）：2.45-24.60）；P<0.001]、使用口服抗凝剂[OR 18.68（95%CI：3.77-92.46）；P<0.0001]、吸烟[OR 5.15（95%CI：1.67-15.84）；P=0.004]、受者年龄>60 岁[OR 7.28（95%CI：2.33-22.69）；P=0.001]、血清白蛋白<40 g/L[OR 5.08（95%CI：1.82-14.19）；P=0.002]、血清钙≥2.42 mM[OR 6.47（95%CI：1.37-30.58）；P=0.02]、活体供者[OR 2.95，（95%CI：0.31-28.29）；P=0.34)]和既往血液透析[OR 3.33，（95%CI：0.39-28.11）；P=0.27)]被纳入该模型。验证模型区分了低危（<3 分）和高危（>8.5 分）受者，死亡率分别为 0%和 54%。与 Charlson 合并症指数（CCI）相比，该模型的受试者工作特征（ROC）曲线下面积显著更高（新型评分 ROC：0.87 vs. CCI：0.72，P=0.0012）。早期移植物丢失与致敏[OR 3.02（95%CI：1.29-7.09）；P=0.011]和丙型肝炎抗体阳性[OR 2.42（95%CI：1.09-5.34）；P=0.029]有关。无法开发出用于预测移植物丢失的风险模型（ROC：0.62）。
基于新型评分的风险分层可能会识别出具有不成比例的早期患者死亡风险的高危受者，并导致优化的策略。
