患者报告结局测量信息系统工具的症状领域组可独立预测肝硬化患者的住院和再次住院情况。
Symptom Domain Groups of the Patient-Reported Outcomes Measurement Information System Tools Independently Predict Hospitalizations and Re-hospitalizations in Cirrhosis.
作者信息
Patidar Kavish R, Thacker Leroy R, Wade James B, White Melanie B, Gavis Edith A, Fagan Andrew, Sterling Richard K, Fuchs Michael, Siddiqui Mohammad S, Matherly Scott, Stravitz Richard T, Sanyal Arun J, Puri Puneet, Luketic Velimir A, Bajaj Jasmohan S
机构信息
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA, USA.
Department of Biostatistics, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA.
出版信息
Dig Dis Sci. 2017 May;62(5):1173-1179. doi: 10.1007/s10620-017-4509-y. Epub 2017 Mar 3.
BACKGROUND
Patient-Reported Outcomes Measurement Information System (PROMIS) tools can identify health-related quality of life (HRQOL) domains that could differentially affect disease progression. Cirrhotics are highly prone to hospitalizations and re-hospitalizations, but the current clinical prognostic models may be insufficient, and thus studying the contribution of individual HRQOL domains could improve prognostication.
AIM
Analyze the impact of individual HRQOL PROMIS domains in predicting time to all non-elective hospitalizations and re-hospitalizations in cirrhosis.
METHODS
Outpatient cirrhotics were administered PROMIS computerized tools. The first non-elective hospitalization and subsequent re-hospitalizations after enrollment were recorded. Individual PROMIS domains significantly contributing toward these outcomes were generated using principal component analysis. Factor analysis revealed three major PROMIS domain groups: daily function (fatigue, physical function, social roles/activities and sleep issues), mood (anxiety, anger, and depression), and pain (pain behavior/impact) accounted for 77% of the variability. Cox proportional hazards regression modeling was used for these groups to evaluate time to first hospitalization and re-hospitalization.
RESULTS
A total of 286 patients [57 years, MELD 13, 67% men, 40% hepatic encephalopathy (HE)] were enrolled. Patients were followed at 6-month (mth) intervals for a median of 38 mths (IQR 22-47), during which 31% were hospitalized [median IQR mths 12.5 (3-27)] and 12% were re-hospitalized [10.5 mths (3-28)]. Time to first hospitalization was predicted by HE, HR 1.5 (CI 1.01-2.5, p = 0.04) and daily function PROMIS group HR 1.4 (CI 1.1-1.8, p = 0.01), independently. In contrast, the pain PROMIS group were predictive of the time to re-hospitalization HR 1.6 (CI 1.1-2.3, p = 0.03) as was HE, HR 2.1 (CI 1.1-4.3, p = 0.03).
CONCLUSIONS
Daily function and pain HRQOL domain groups using PROMIS tools independently predict hospitalizations and re-hospitalizations in cirrhotic patients.
背景
患者报告结局测量信息系统（PROMIS）工具可识别可能对疾病进展产生不同影响的健康相关生活质量（HRQOL）领域。肝硬化患者极易发生住院和再次住院情况，但目前的临床预后模型可能并不充分，因此研究个体HRQOL领域的作用可能会改善预后。
目的
分析个体HRQOL的PROMIS领域对预测肝硬化患者所有非择期住院和再次住院时间的影响。
方法
对门诊肝硬化患者使用PROMIS计算机化工具。记录入组后的首次非择期住院及随后的再次住院情况。使用主成分分析得出对这些结局有显著影响的个体PROMIS领域。因子分析揭示了三个主要的PROMIS领域组：日常功能（疲劳、身体功能、社会角色/活动和睡眠问题）、情绪（焦虑、愤怒和抑郁）以及疼痛（疼痛行为/影响），它们占变异性的77%。对这些组使用Cox比例风险回归模型来评估首次住院和再次住院的时间。
结果
共纳入286例患者[年龄57岁，终末期肝病模型（MELD）评分为13，67%为男性，40%有肝性脑病（HE）]。患者每隔6个月随访一次，中位随访时间为38个月（四分位间距22 - 47个月），在此期间31%的患者住院[中位住院时间及四分位间距为12.5个月（3 - 27个月）]，12%的患者再次住院[10.5个月（3 - 28个月）]。首次住院时间由HE独立预测，风险比（HR）为1.5（95%置信区间1.01 - 2.5，p = 0.04），日常功能PROMIS组的HR为1.4（95%置信区间1.1 - 1.8，p = 0.01）。相比之下，疼痛PROMIS组可预测再次住院时间，HR为1.6（95%置信区间1.1 - 2.3，p = 0.03），HE也是如此，HR为2.1（95%置信区间1.1 - 4.3，p = 0.03）。
结论
使用PROMIS工具的日常功能和疼痛HRQOL领域组可独立预测肝硬化患者的住院和再次住院情况。
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