Ahn John H, Waller Jennifer L, Baer Stephanie L, Colombo Rhonda E, Kheda Mufaddal F, Nahman N Stanley, Turrentine Jake E
Department of Medicine, Augusta University, Augusta, GA, USA.
Department of Population Health Sciences, Augusta University, Augusta, GA, USA.
Clin Kidney J. 2019 Feb;12(1):101-105. doi: 10.1093/ckj/sfy058. Epub 2018 Jul 17.
End-stage renal disease (ESRD) patients have increased risk of developing herpes zoster (zoster) compared with the general population, but mortality risk is unknown. We assessed the risk of mortality in hospitalized ESRD patients with a diagnosis of zoster from the inpatient hospital files (as opposed to outpatient records) of the United States Renal Data System.
This study analyzed incident ESRD patients from 2006 to 2009. Based on an diagnosis code of zoster infection, we determined 2-year mortality following an inpatient diagnosis. Cox proportional hazards models were used to examine the association of mortality and zoster, when controlling for demographic and other clinical risk factors.
Zoster was diagnosed in 2784 patients, 51% of whom died within 2 years, with a mean time to death of 8.1 months. Patients who died were more likely to be white and older, score higher on the Charlson Comorbidity Index (CCI) and have other clinical diagnoses besides CCI. Increased risk of death within 2 years was associated with older age (adjusted hazard ratio 1.03), malnutrition (1.31), bacteremia/septicemia (1.16) and increasing CCI (1.10). Zoster vaccine was administered to 27 patients, but the small number precluded analysis of its impact.
Mortality in ESRD patients with an inpatient zoster diagnosis is increased with older age and higher severity of clinical comorbidities. The role of zoster vaccination on mortality in this population remains to be defined.
与普通人群相比，终末期肾病（ESRD）患者发生带状疱疹（zoster）的风险增加，但死亡风险尚不清楚。我们从美国肾脏数据系统的住院病历（而非门诊记录）中评估了诊断为带状疱疹的住院ESRD患者的死亡风险。
本研究分析了2006年至2009年的新发ESRD患者。根据带状疱疹感染的诊断代码，我们确定了住院诊断后的2年死亡率。在控制人口统计学和其他临床风险因素时，使用Cox比例风险模型来检验死亡率与带状疱疹之间的关联。
2784例患者被诊断为带状疱疹，其中51%在2年内死亡，平均死亡时间为8.1个月。死亡患者更可能是白人且年龄较大，在Charlson合并症指数（CCI）上得分较高，并且除CCI外还有其他临床诊断。2年内死亡风险增加与年龄较大（调整后的风险比为1.03）、营养不良（1.31）、菌血症/败血症（1.16）以及CCI增加（1.10）相关。27例患者接种了带状疱疹疫苗，但由于数量较少，无法分析其影响。
住院诊断为带状疱疹的ESRD患者的死亡率随着年龄的增长和临床合并症严重程度的增加而升高。带状疱疹疫苗在该人群中对死亡率的作用仍有待确定。
