Park J Y, Kim M H, Bae E J, Kim S, Kim D K, Joo K W, Kim Y S, Lee J P, Kim Y H, Lim C S
Department of Internal Medicine, Dongguk University Ilsan Hospital, Gyeonggi-do, Korea.
Department of Dental Hygiene, College of Health Science, Eulji University, Gyeonggi-do, Korea.
Transplant Proc. 2018 May;50(4):1068-1073. doi: 10.1016/j.transproceed.2018.01.044.
Comorbid conditions are important in the survival of kidney transplant recipients. The weights assigned to comorbidities to predict survival may vary based on the type of index disease and advances in the management of comorbidities. We aimed to develop a modified Charlson comorbidity index (CCI) in renal allograft recipients (mCCI-KT), thereby improving risk stratification for mortality.
A total of 3765 recipients in a multicenter cohort were included to develop a comorbidity score. The weights of the comorbidities, per the CCI, were recalibrated using a Cox proportional hazards model.
Peripheral vascular disease, liver disease, myocardial infarction, and diabetes in the CCI were selected from the Cox proportional hazards model. Thus, the mCCI-KT included 4 comorbidities with recalibrated severity weights. Whereas the CCI did not discriminate for survival, the mCCI-KT provided significant discrimination for survival using the Kaplan-Meier method and Cox regression analysis. The mCCI-KT showed modest increases in c-statistics (0.54 vs 0.52, P = .001) and improved net mortality risk reclassification by 16.3% (95% confidence interval, 3.2-29.4; P = .015) relative to the CCI.
The mCCI-KT stratifies the risk for mortality in renal allograft recipients better than the CCI, suggesting that it may be a preferred index for use in clinical practice.
合并症对肾移植受者的生存至关重要。用于预测生存的合并症权重可能因索引疾病类型和合并症管理进展而有所不同。我们旨在开发一种肾移植受者改良查尔森合并症指数（mCCI-KT），从而改善死亡风险分层。
纳入一个多中心队列中的3765名受者以制定合并症评分。使用Cox比例风险模型重新校准CCI中合并症的权重。
从Cox比例风险模型中选取了CCI中的外周血管疾病、肝脏疾病、心肌梗死和糖尿病。因此，mCCI-KT包括4种合并症，其严重程度权重经过重新校准。CCI对生存情况无区分能力，而mCCI-KT使用Kaplan-Meier方法和Cox回归分析对生存情况有显著区分能力。与CCI相比，mCCI-KT的c统计量有适度增加（0.54对0.52，P = .001），净死亡风险重新分类改善了16.3%（95%置信区间，3.2 - 29.4；P = .015）。
mCCI-KT对肾移植受者死亡风险的分层优于CCI，表明它可能是临床实践中更优选的指数。
