Junkkari Antti, Roine Risto P, Luikku Antti, Rauramaa Tuomas, Sintonen Harri, Nerg Ossi, Koivisto Anne M, Häyrinen Antti, Viinamäki Heimo, Soininen Hilkka, Jääskeläinen Juha E, Leinonen Ville
Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland; Group Administration, Helsinki and Uusimaa Hospital District, Helsinki, Finland.
World Neurosurg. 2017 Dec;108:356-366. doi: 10.1016/j.wneu.2017.08.170. Epub 2017 Sep 5.
Occasionally, a favorable clinical disease-specific outcome does not reflect into improved generic health-related quality of life (HRQoL) in patients with idiopathic normal-pressure hydrocephalus (iNPH) at 1 year after the installation of a cerebrospinal fluid shunt. Our aim was to identify factors causing this discrepancy.
The 1-year HRQoL outcomes of 141 patients with iNPH were evaluated with the generic 15D instrument, in which the minimum clinically important change/difference on the 0-1 scale has been estimated to be ±0.015. A 12-point iNPH grading scale (iNPHGS) was used as a clinical disease-specific outcome measure, in which a 1-point decrease is considered to be clinically important. We identified 29 (21%) patients with iNPH from our prospective study whose HRQoL deteriorated or remained the same despite of a favorable iNPHGS outcome. We analyzed this discrepancy using patients' clinical variables and characteristics.
Multivariate binary logistic regression analysis indicated that a greater (worse) iNPHGS score at baseline (adjusted odds ratio [OR], 1.7; 95% confidence interval [CI] 1.3-2.3; P < 0.001), comorbid chronic pulmonary disease (40% vs. 20%; adjusted OR 17.8; 95% CI 3.6-89.9; P < 0.001), and any comorbid nonmetastatic tumor (62% vs. 17%; adjusted OR 11.5; 95% CI 1.5-85.3; P = 0.017) predicted discrepancy between iNPHGS and 15D outcomes.
Frail patients suffering from certain pre-existing comorbidities may not experience improvement in generic HRQoL despite of a favorable clinical disease-specific response. Acknowledging the comorbidity burden of the patient may help clinicians and the patients to understand the conflict between patient-reported and clinical outcomes.
对于特发性正常压力脑积水（iNPH）患者，在脑脊液分流术后1年，有时良好的疾病特异性临床结局并未转化为改善的一般健康相关生活质量（HRQoL）。我们的目的是确定导致这种差异的因素。
使用通用的15D工具评估141例iNPH患者的1年HRQoL结局，在该工具中，0至1量表上的最小临床重要变化/差异估计为±0.015。使用12分的iNPH分级量表（iNPHGS）作为疾病特异性临床结局指标，其中1分的降低被认为具有临床意义。我们从前瞻性研究中确定了29例（21%）iNPH患者，尽管iNPHGS结局良好，但他们的HRQoL恶化或保持不变。我们使用患者的临床变量和特征分析了这种差异。
多变量二元逻辑回归分析表明，基线时iNPHGS评分更高（更差）（调整后的优势比[OR]，1.7；95%置信区间[CI] 1.3 - 2.3；P < 0.001）、合并慢性肺病（40%对20%；调整后的OR 17.8；95% CI 3.6 - 89.9；P < 0.001）以及任何合并非转移性肿瘤（62%对17%；调整后的OR 11.5；95% CI 1.5 - 85.3；P = 0.017）可预测iNPHGS与15D结局之间的差异。
尽管有良好的疾病特异性临床反应，但患有某些既有合并症的虚弱患者可能不会在一般HRQoL方面有所改善。认识到患者的合并症负担可能有助于临床医生和患者理解患者报告的结局与临床结局之间的冲突。
