根据五个估计肾小球滤过率方程预测老年社区居民的生存情况：InChianti 研究。
Predicting survival of older community-dwelling individuals according to five estimated glomerular filtration rate equations: The InChianti study.
机构信息
Unit of Geriatric Pharmacoepidemiology, Italian National Research Center on Aging, Cosenza, Italy.
Unit of Geriatric Medicine, University Campus Biomedico, Rome, Italy.
出版信息
Geriatr Gerontol Int. 2018 Apr;18(4):607-614. doi: 10.1111/ggi.13225. Epub 2018 Jan 22.
AIMS
There is uncertainty about which estimated glomerular filtration rate eGFR equation to use in older people with respect to the prediction of prognosis. Our aim was: (i) to compare the discriminative capacity of eGFR estimated by different equations with respect to all-cause mortality; and (ii) to identify the eGFR threshold at which the risk of mortality starts to increase for each equation.
METHODS
We used data from 828 community-dwelling older adults aged >65 years enrolled in the InCHIANTI study. The outcome measure was all-cause mortality at 9 years. GFR was estimated by five different equations: Chronic Kidney Disease Epidemiological Collaboration (creatinine equation [CKD-EPI ], and creatinine and cystatin C equation [CKD-EPI ]), Berlin Initiative Study (BIS and BIS ) and full age spectrum. Sensitivity, specificity, areas under receiver operating curve (AUC) and C-statistics were used to compare their predictive capacity.
RESULTS
The best mix of sensitivity, specificity, AUC and C-statistic value in predicting mortality was observed with BIS equations. BIS (AUC 0.65, 95% CI 0.61-0.69) outperformed both CKD-EPI (AUC 0.60, 95% CI 0.56-0.64; P = 0.005) and full age spectrum (AUC 0.63, 95% CI 0.59-0.67; P = 0.002) in terms of predictivity. Similarly, BIS (AUC 0.67, 95% CI 0.63-0.71) outperformed CKD-EPI (AUC 0.63, 95% CI 0.59-0.67; P = 0.01). AUC obtained with equations also including cystatin C were not significantly different compared with their creatinine-based counterparts. The risk of long-term mortality began to increase at under 65.6 mL/min/1.73 m for CKD-EPI , 60.5 for CKD-EPI , 60 for BIS , 56.3 for BIS and 55.2 for full age spectrum.
CONCLUSIONS
The BIS equation discriminates the risk of all-cause mortality better than other equations in older community-dwelling individuals. The eGFR threshold under which mortality starts to increase could change as a function of the equation used. Geriatr Gerontol Int 2018; 18: 607-614.
目的
在预测预后方面，对于老年人来说，哪种肾小球滤过率估计（eGFR）方程存在不确定性。我们的目的是：（i）比较不同方程估计的 eGFR 对全因死亡率的区分能力；（ii）确定每个方程中 eGFR 阈值开始增加的死亡率风险。
方法
我们使用了来自 828 名年龄> 65 岁的社区居住老年人的 INCHIANTI 研究数据。主要结局是 9 年的全因死亡率。通过五种不同的方程估计 GFR：慢性肾脏病流行病学合作研究（肌酐方程[CKD-EPI]和肌酐和胱抑素 C 方程[CKD-EPI]）、柏林倡议研究（BIS 和 BIS ）和全年龄谱。使用敏感性、特异性、受试者工作特征曲线下面积（AUC）和 C 统计量来比较其预测能力。
结果
在预测死亡率方面，BIS 方程的敏感性、特异性、AUC 和 C 统计量的最佳组合。BIS（AUC 0.65，95%CI 0.61-0.69）在预测能力方面优于 CKD-EPI（AUC 0.60，95%CI 0.56-0.64；P = 0.005）和全年龄谱（AUC 0.63，95%CI 0.59-0.67；P = 0.002）。同样，BIS（AUC 0.67，95%CI 0.63-0.71）优于 CKD-EPI（AUC 0.63，95%CI 0.59-0.67；P = 0.01）。与基于肌酐的方程相比，包含胱抑素 C 的方程的 AUC 没有显著差异。CKD-EPI 为 65.6 mL/min/1.73 m，CKD-EPI 为 60.5，BIS 为 60，BIS 为 56.3，全年龄谱为 55.2，全因死亡率开始增加的风险开始增加。
结论
在社区居住的老年人中，BIS 方程比其他方程更能区分全因死亡率的风险。死亡率开始增加的 eGFR 阈值可能会随着所使用的方程而变化。老年医学与老年病学国际 2018；18：607-614。
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