Orman Eric S, Ghabril Marwan, Chalasani Naga
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana.
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana.
Clin Gastroenterol Hepatol. 2016 Aug;14(8):1189-1195.e1. doi: 10.1016/j.cgh.2016.03.036. Epub 2016 Apr 1.
BACKGROUND & AIMS: Functional status (a patient's ability to perform activities that meet basic needs, fulfill usual roles, and maintain health and well-being) has been linked to outcomes in patients with cirrhosis and can be measured by the Karnofsky performance status (KPS) scale. We investigated the association between KPS score and mortality in patients with cirrhosis.
We used the United Network for Organ Sharing database to perform a retrospective cohort study of patients listed for liver transplantation in the United States between 2005 and 2015. We used Cox proportional hazards and competing risk regression analyses to examine the association between KPS and mortality and transplantation.
Of 79,092 patients, 44% were in KPS category A (KPS, 80%-100%), 43% were in category B (KPS, 50%-70%), and 13% were in category C (KPS, 10%-40%). Between 2005 and 2015, the proportion of patients in category A decreased from 53% to 35%, whereas the proportions in categories B and C increased from 36% to 49% and from 11% to 16%, respectively. KPS was associated with mortality: compared with patients in KPS category A, the KPS B adjusted hazard ratio (HR) was 1.14 (95% confidence interval [CI], 1.11-1.18) and the KPS C adjusted HR was 1.63 (95% CI, 1.55-1.72). KPS was also associated with liver transplantation; compared with patients in KPS category A, the KPS B adjusted HR was 1.08 (95% CI, 1.06-1.11) and the KPS C adjusted HR was 1.35 (95% CI, 1.30-1.40). In competing risk analysis, only the relationship between KPS and mortality maintained significance and directionality. These relationships were most pronounced in patients without hepatocellular carcinoma.
Among patients with cirrhosis listed for liver transplantation, poor performance status, based on the KPS scale, is associated with increased mortality. In this population, performance status has decreased over time.
功能状态（患者进行满足基本需求、履行日常职责以及维持健康和幸福的活动的能力）已与肝硬化患者的预后相关联，并且可以通过卡诺夫斯基功能状态（KPS）量表进行衡量。我们研究了KPS评分与肝硬化患者死亡率之间的关联。
我们使用器官共享联合网络数据库对2005年至2015年期间在美国列入肝移植名单的患者进行了一项回顾性队列研究。我们使用Cox比例风险模型和竞争风险回归分析来检验KPS与死亡率及移植之间的关联。
在79092例患者中，44%属于KPS A类（KPS，80%-100%），43%属于B类（KPS，50%-70%），13%属于C类（KPS，10%-40%）。在2005年至2015年期间，A类患者的比例从53%降至35%，而B类和C类患者的比例分别从36%增至49%以及从11%增至16%。KPS与死亡率相关：与KPS A类患者相比，KPS B类的调整后风险比（HR）为1.14（95%置信区间[CI]，1.11-1.18），KPS C类的调整后HR为1.63（95%CI，1.55-1.72）。KPS也与肝移植相关；与KPS A类患者相比，KPS B类的调整后HR为1.08（95%CI，1.06-1.11），KPS C类的调整后HR为1.35（95%CI，1.30-1.40）。在竞争风险分析中，只有KPS与死亡率之间的关系保持显著和方向性。这些关系在无肝细胞癌的患者中最为明显。
在列入肝移植名单的肝硬化患者中，基于KPS量表的较差功能状态与死亡率增加相关。在这一人群中，功能状态随时间有所下降。
