非瓣膜性心房颤动中的慢性肾脏病晚期：将 R2CHADS2 评分系统的应用扩展至肾衰竭晚期患者。
Advanced chronic kidney disease in non-valvular atrial fibrillation: extending the utility of R2CHADS2 to patients with advanced renal failure.
机构信息
Department of Medicine , Metropolitan Hospital Center , New York, NY , USA.
Section of Nephrology, Department of Internal Medicine , Metropolitan Hospital Center, New York Medical College , New York, NY , USA.
出版信息
Clin Kidney J. 2015 Apr;8(2):226-31. doi: 10.1093/ckj/sfv006. Epub 2015 Feb 16.
BACKGROUND
The R2CHADS2 is a new prediction rule for stroke risk in atrial fibrillation (AF) patients wherein R stands for renal risk. However, it was created from a cohort that excluded patients with advanced renal failure (defined as glomerular filtration rate of <30 mL/min). Our study extends the use of R2CHADS2 to patients with advanced renal failure and aims to compare its predictive power against the currently used CHADS and CHA2DS2VaSc.
METHODS
This retrospective cohort study analyzed the 1-year risk for stroke of the 524 patients with AF at Metropolitan Hospital Center. AUC and C statistics were calculated using three groups: (i) the entire cohort including patients with advanced renal failure, (ii) a cohort excluding patients with advanced renal failure and (iii) all patients with GFR < 30 mL/min only.
RESULTS
R2CHADS2, as a predictor for stroke risk, consistently performs better than CHADS2 and CHA2DS2VsC in groups 1 and 2. The C-statistic was highest in R2CHADS compared with CHADS or CHADSVASC in group 1 (0.718 versus 0.605 versus 0.602) and in group 2 (0.724 versus 0.584 versus 0.579). However, there was no statistically significant difference in group 3 (0.631 versus 0.629 versus 0.623).
CONCLUSION
Our study supports the utility of R2CHADS2 as a clinical prediction rule for stroke risk in patients with advanced renal failure.
背景
R2CHADS2 是一种新的房颤（AF）患者中风风险预测规则，其中 R 代表肾脏风险。然而，它是从一个排除了晚期肾衰竭（定义为肾小球滤过率<30mL/min）患者的队列中创建的。我们的研究将 R2CHADS2 的用途扩展到晚期肾衰竭患者，并旨在比较其预测能力与目前使用的 CHADS 和 CHA2DS2VaSc。
方法
这项回顾性队列研究分析了大都会医院中心的 524 名 AF 患者的 1 年中风风险。使用三组计算 AUC 和 C 统计量：（i）包括晚期肾衰竭患者的整个队列，（ii）排除晚期肾衰竭患者的队列，以及（iii）仅包括 GFR<30mL/min 的所有患者。
结果
作为中风风险的预测因子，R2CHADS2 在第 1 组和第 2 组中始终优于 CHADS2 和 CHA2DS2VsC。C 统计量在 R2CHADS2 中最高，与 CHADS 或 CHADSVASC 在第 1 组（0.718 与 0.605 与 0.602）和第 2 组（0.724 与 0.584 与 0.579）相比。然而，在第 3 组中（0.631 与 0.629 与 0.623），这没有统计学上的显著差异。
结论
我们的研究支持 R2CHADS2 作为晚期肾衰竭患者中风风险的临床预测规则的实用性。
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