终末期肾病患者健康相关生活质量作为死亡率预测指标的观察性研究
Health-related quality of life as predictor of mortality in end-stage renal disease patients: an observational study.
作者信息
Pei Ming, Aguiar Rute, Pagels Agneta A, Heimbürger Olof, Stenvinkel Peter, Bárány Peter, Medin Charlotte, Jacobson Stefan H, Hylander Britta, Lindholm Bengt, Qureshi Abdul Rashid
机构信息
Renal Medicine and Baxter Novum, Clintec, M99, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden.
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
出版信息
BMC Nephrol. 2019 Apr 29;20(1):144. doi: 10.1186/s12882-019-1318-x.
BACKGROUND
Health-related quality of life (HRQoL) is an important component of patient-centered outcomes and a useful parameter for monitoring quality of care. We assessed HRQoL, its determinants, and associations with mortality in patients with end-stage renal disease (ESRD).
METHODS
Short Form-36 was used to assess HRQoL, its domain components, and physical (PCS) and mental (MCS) composite summary scores in altogether 400 (338 incident and 62 prevalent) dialysis patients with median age 64 years, 37% women, 24% diabetes mellitus (DM), 49% cardiovascular disease (CVD), and median estimated glomerular filtration rate (eGFR) of 5.3 (3.0-9.4) ml/min/1.73. Results were analyzed separately for 338 incident patients starting on hemodialysis (HD; 68%) or peritoneal dialysis (PD; 32%), and 62 prevalent PD patients. Mortality risk was analyzed during up to 60 months (median 28 months).
RESULTS
Linear multivariate regression analysis showed that in incident dialysis patients, 1-SD higher PCS associated negatively with 1-SD higher age, DM and CVD, and positively with 1-SD higher hemoglobin and sodium (adjusted r = 0.17). In 62 prevalent PD patients, 1-SD higher PCS was negatively associated with 1-SD higher age. MCS was not associated to any of the investigated factors. Multivariate Cox regression analysis showed that in incident dialysis patients, 1-SD increase of PCS associated with lower all-cause mortality, hazard ratio 0.65 (95% confidence interval 0.52-0.81), after adjustments for age, sex, DM, CVD, plasma albumin, C-reactive protein and eGFR whereas 1-SD lower MCS did not associate with mortality. In PD patients, neither PCS nor MCS associated with mortality.
CONCLUSIONS
MCS did not associate with any of the investigated clinical factors, whereas lower PCS associated with higher age, CVD, DM, and lower hemoglobin and sodium levels. MCS was not associated with mortality, whereas lower PCS associated with increased mortality risk. These results suggest that HRQoL - in addition to its role as patient-centered outcome - matters also for hard clinical outcomes in ESRD patients. Our knowledge about factors influencing MCS in ESRD patients is limited and should motivate further studies.
背景
健康相关生活质量（HRQoL）是以患者为中心的结局的重要组成部分，也是监测医疗质量的有用参数。我们评估了终末期肾病（ESRD）患者的HRQoL、其决定因素以及与死亡率的关联。
方法
采用简短健康调查问卷（Short Form-36）评估400例（338例新发病例和62例现患病例）透析患者的HRQoL、其领域组成部分以及身体（PCS）和心理（MCS）综合汇总评分，这些患者的中位年龄为64岁，女性占37%，糖尿病（DM）患者占24%，心血管疾病（CVD）患者占49%，中位估计肾小球滤过率（eGFR）为5.3（3.0 - 9.4）ml/min/1.73。分别对338例开始进行血液透析（HD；68%）或腹膜透析（PD；32%）的新发病例患者以及62例现患PD患者的结果进行分析。在长达60个月（中位时间28个月）内分析死亡风险。
结果
线性多变量回归分析显示，在新发病例透析患者中，PCS每升高1个标准差与年龄、DM和CVD每升高1个标准差呈负相关，与血红蛋白和钠每升高1个标准差呈正相关（调整后的r = 0.17）。在62例现患PD患者中，PCS每升高1个标准差与年龄每升高1个标准差呈负相关。MCS与任何研究因素均无关联。多变量Cox回归分析显示，在新发病例透析患者中，调整年龄、性别、DM、CVD、血浆白蛋白、C反应蛋白和eGFR后，PCS每升高1个标准差与全因死亡率降低相关，风险比为0.65（95%置信区间0.52 - 0.81），而MCS每降低1个标准差与死亡率无关。在PD患者中，PCS和MCS均与死亡率无关。
结论
MCS与任何研究的临床因素均无关联，而较低的PCS与较高的年龄、CVD、DM以及较低的血红蛋白和钠水平相关。MCS与死亡率无关，而较低的PCS与死亡风险增加相关。这些结果表明，HRQoL除了作为以患者为中心的结局外，对ESRD患者的硬临床结局也很重要。我们对影响ESRD患者MCS的因素的了解有限，应推动进一步研究。
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