Siriopol Dimitrie, Voroneanu Luminita, Hogas Simona, Apetrii Mugurel, Gramaticu Angelica, Dumea Raluca, Burlacu Alexandru, Sascau Radu, Kanbay Mehmet, Covic Adrian
University of Medicine and Pharmacy "Gr.T.Popa", Iasi, Romania.
Nephrology Department, "Dr. C.I. Parhon" University Hospital, Bld. Copou, No. 50, 700503, Iasi, Romania.
Int J Cardiovasc Imaging. 2016 Feb;32(2):263-270. doi: 10.1007/s10554-015-0768-x. Epub 2015 Oct 1.
Fluid overload is associated with adverse outcomes in hemodialysis (HD) patients. Two bedside methods are increasingly utilized to evaluate objectively fluid status-bioimpedance and lung ultrasonography, but there is no available direct, head-to-head comparison of their prognostic significance. Importantly, their predictive abilities have never been tested in a HD population, alongside those of a classic model that also incorporates established echocardiographic parameters of increased mortality risk. Between 26 May 2011 and 26 October 2012, we included in the study 173 patients undergoing chronic HD treatment for at least 3 months in a single dialysis unit. Relative fluid overload (RFO) and B-lines score (BLS) were used as candidate predictors. From Cox survival analysis we evaluated the increase in the predictive abilities for all-cause mortality of adding continuous RFO or BLS to a model including conventional predictors . 31 patients (17.9 %) died during a median follow-up of 21.3 (interquartile range 19.9-30.3) months. All Cox models showed good calibration. The C statistic for the all-cause mortality prediction increased significantly when the RFO was included into the baseline model (ΔC statistics 0.058 95 %CI = 0.003-0.114), but not when the BLS was included into the baseline model. Only the model that incorporated RFO showed significantly better risk reclassification abilities than the baseline model (IDI = 3.6 % and continuous NRI = 24.8 %). Fluid overload, as assessed by bioimpedance, and not by lung ultrasonography, improves risk prediction for death, beyond classical and echocardiographic-based risk prediction scores/parameters.
液体过载与血液透析（HD）患者的不良预后相关。两种床旁方法越来越多地用于客观评估液体状态——生物电阻抗和肺部超声检查，但尚无关于它们预后意义的直接、面对面比较。重要的是，它们的预测能力从未在HD人群中与一个经典模型一起进行过测试，该经典模型还纳入了已确定的增加死亡风险的超声心动图参数。在2011年5月26日至2012年10月26日期间，我们纳入了在单个透析单元接受慢性HD治疗至少3个月的173例患者。相对液体过载（RFO）和B线评分（BLS）用作候选预测指标。通过Cox生存分析，我们评估了在包含传统预测指标的模型中加入连续RFO或BLS后，全因死亡率预测能力的提高。在中位随访21.3（四分位间距19.9 - 30.3）个月期间，31例患者（17.9%）死亡。所有Cox模型均显示出良好的校准。当将RFO纳入基线模型时，全因死亡率预测的C统计量显著增加（ΔC统计量0.058，95%CI = 0.003 - 0.114），但将BLS纳入基线模型时则未增加。只有纳入RFO的模型显示出比基线模型显著更好的风险重新分类能力（综合鉴别改善率 = 3.6%，连续净重新分类指数 = 24.8%）。通过生物电阻抗而非肺部超声检查评估的液体过载，在经典和基于超声心动图的风险预测评分/参数之外，改善了死亡风险预测。
