Watford Daniel J, Cheng Xingxing S, Han Jialin, Stedman Margaret R, Chertow Glenn M, Tan Jane C
Division of Nephrology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA.
Clin Transplant. 2021 Feb;35(2):e14173. doi: 10.1111/ctr.14173. Epub 2020 Dec 14.
Frailty is associated with adverse kidney transplant outcomes and can be assessed by subjective and objective metrics. There is increasing recognition of the value of metrics obtainable remotely. We compared the self-reported SF-36 physical functioning subscale score (SF-36 PF) with in-person physical performance tests (6-min walk and sit-to-stand) in a prospective cohort of kidney transplant candidates. We assessed each metric's ability to predict time to the composite outcome of waitlist removal or death, censoring at transplant. We built time-dependent receiver operating characteristic curves and calculated the area under the curve [AUC(t)] at 1 year, using bootstrapping for internal validation. In 199 patients followed for a median of 346 days, 41 reached the composite endpoint. Lower SF-36 PF scores were associated with higher risk of waitlist removal/death, with every 10-point decrease corresponding to a 16% increase in risk. All models showed an AUC(t) of 0.83-0.84 that did not contract substantially after internal validation. Among kidney transplant candidates, SF-36 PF, obtainable remotely, can help to stratify the risk of waitlist removal or death, and may be used as a screening tool for poor physical functioning in ongoing candidate evaluation, particularly where travel, increasing patient volume, or other restrictions challenge in-person assessment.
衰弱与肾移植不良结局相关，可通过主观和客观指标进行评估。人们越来越认识到可远程获取的指标的价值。我们在前瞻性队列的肾移植候选者中，比较了自我报告的SF-36身体功能分量表评分（SF-36 PF）与现场身体性能测试（6分钟步行和从坐到站测试）。我们评估了每个指标预测等待名单移除或死亡这一复合结局发生时间的能力，在移植时进行截尾。我们构建了时间依赖性受试者工作特征曲线，并使用自抽样法进行内部验证，计算了1年时的曲线下面积[AUC(t)]。在199例中位随访346天的患者中，41例达到复合终点。较低的SF-36 PF评分与等待名单移除/死亡的较高风险相关，每降低10分，风险增加16%。所有模型的AUC(t)为0.83 - 0.84，内部验证后变化不大。在肾移植候选者中，可远程获取的SF-36 PF有助于对等待名单移除或死亡的风险进行分层，并可在持续的候选者评估中用作身体功能不佳的筛查工具，特别是在旅行、患者数量增加或其他限制因素对现场评估构成挑战的情况下。
