Ma Terry King-Wing, Chow Kai Ming, Kwan Bonnie Ching-Ha, Ng Jack Kit-Chung, Pang Wing-Fai, Leung Chi Bon, Li Philip Kam-To, Szeto Cheuk Chun
Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Clin Exp Nephrol. 2018 Feb;22(1):159-166. doi: 10.1007/s10157-017-1418-5. Epub 2017 May 29.
Several comorbidity scoring systems have been developed and validated, mostly in western hemodialysis patients with a high risk of cardiovascular disease. The performance of comorbidity scoring, however, depends on the patient population. In this study, we determine the optimal comorbidity scoring system for predicting survival of incident Chinese PD patients.
We studied 461 incident PD patients. The performance of Charlson Comorbidity Index (CCI), Hemmelgarn score, and Liu score as the survival predictor was compared.
The mean age was 57.7 ± 13.7 years. The median CCI, Hemmelgarn, and Liu scores were 4 [inter-quartile range (IQR) 2-5], 1 (IQR 0-2), and 4 (IQR 2-5), respectively. Patients were followed for 45.5 ± 33.0 months. All 3 comorbidity scores were predictors of patient survival by univariate analysis. After adjusting for confounding factors, CCI was the best predictor of patient survival among the 3 indices, with each point increase in CCI conferring 31% excess in mortality risk [95% confidence interval (CI) 21-41%, p < 0.001]. In contrast, each point increase in Liu score confers 20% excess in mortality risk (95% CI 13-27%, p < 0.001). Although the Hemmelgarn score is an independent predictor of patient survival, over 70% of patients score 0 or 1 by this system, limiting its role as a prognostic marker.
CCI should be the preferred method for quantifying comorbidity load in incident Chinese PD patients, and it is a good predictor of survival in this group of patients.
已经开发并验证了几种合并症评分系统，大多是针对心血管疾病风险较高的西方血液透析患者。然而，合并症评分的表现取决于患者群体。在本研究中，我们确定预测新接受腹膜透析（PD）治疗的中国患者生存率的最佳合并症评分系统。
我们研究了461例新接受PD治疗的患者。比较了Charlson合并症指数（CCI）、Hemmelgarn评分和Liu评分作为生存预测指标的表现。
平均年龄为57.7±13.7岁。CCI、Hemmelgarn和Liu评分的中位数分别为4[四分位间距（IQR）2 - 5]、1（IQR 0 - 2）和4（IQR 2 - 5）。患者随访时间为45.5±33.0个月。单因素分析显示，所有3种合并症评分都是患者生存的预测指标。在调整混杂因素后，CCI是3个指标中患者生存的最佳预测指标，CCI每增加1分，死亡风险增加31%[95%置信区间（CI）21 - 41%，p<0.001]。相比之下，Liu评分每增加1分，死亡风险增加20%（95%CI 13 - 27%，p<0.001）。虽然Hemmelgarn评分是患者生存的独立预测指标，但该系统中超过70%的患者评分为0或1，限制了其作为预后标志物的作用。
CCI应是量化新接受PD治疗的中国患者合并症负担的首选方法，并且是该组患者生存的良好预测指标。
