McAdams-DeMarco M A, Law A, King E, Orandi B, Salter M, Gupta N, Chow E, Alachkar N, Desai N, Varadhan R, Walston J, Segev D L
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Am J Transplant. 2015 Jan;15(1):149-54. doi: 10.1111/ajt.12992. Epub 2014 Oct 30.
We have previously described strong associations between frailty, a measure of physiologic reserve initially described and validated in geriatrics, and early hospital readmission as well as delayed graft function. The goal of this study was to estimate its association with postkidney transplantation (post-KT) mortality. Frailty was prospectively measured in 537 KT recipients at the time of transplantation between November 2008 and August 2013. Cox proportional hazards models were adjusted for confounders using a novel approach to substantially improve model efficiency and generalizability in single-center studies. We precisely estimated the confounder coefficients using the large sample size of the Scientific Registry of Transplantation Recipients (n = 37 858) and introduced these into the single-center model, which then estimated the adjusted frailty coefficient. At 5 years, the survivals were 91.5%, 86.0% and 77.5% for nonfrail, intermediately frail and frail KT recipients, respectively. Frailty was independently associated with a 2.17-fold (95% CI: 1.01-4.65, p = 0.047) higher risk of death. In conclusion, regardless of age, frailty is a strong, independent risk factor for post-KT mortality, even after carefully adjusting for many confounders using a novel, efficient statistical approach.
我们之前曾描述过虚弱（一种最初在老年医学中描述并验证的生理储备指标）与早期医院再入院以及移植肾功能延迟之间的密切关联。本研究的目的是评估其与肾移植术后（post-KT）死亡率的关联。在2008年11月至2013年8月期间，对537名肾移植受者在移植时进行了前瞻性虚弱测量。使用一种新方法对Cox比例风险模型进行混杂因素调整，以显著提高单中心研究中模型的效率和通用性。我们利用移植受者科学登记处的大样本量（n = 37858）精确估计了混杂因素系数，并将其引入单中心模型，然后该模型估计了调整后的虚弱系数。5年时，非虚弱、中度虚弱和虚弱的肾移植受者的生存率分别为91.5%、86.0%和77.5%。虚弱与死亡风险高出2.17倍（95%CI：1.01 - 4.65，p = 0.047）独立相关。总之，无论年龄如何，即使在使用一种新颖、有效的统计方法仔细调整了许多混杂因素之后，虚弱仍是肾移植术后死亡率的一个强大独立危险因素。
