Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Respiratory Medicine, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan.
Respir Res. 2021 Apr 21;22(1):116. doi: 10.1186/s12931-021-01715-x.
Waitlist mortality due to donor shortage for lung transplantation is a serious problem worldwide. Currently, the selection of recipients in Japan is mainly based on the registration order. Hence, scientific evidence for risk stratification regarding waitlist mortality is urgently needed. We hypothesized that patient-reported dyspnea and health would predict mortality in patients waitlisted for lung transplantation.
We analyzed factors related to waitlist mortality using data of 203 patients who were registered as candidates for lung transplantation from deceased donors. Dyspnea was evaluated using the modified Medical Research Council (mMRC) dyspnea scale, and the health status was determined with St. George's Respiratory Questionnaire (SGRQ).
Among 197 patients who met the inclusion criteria, the main underlying disease was interstitial lung disease (99 patients). During the median follow-up period of 572 days, 72 patients died and 96 received lung transplantation (69 from deceased donors). Univariable competing risk analyses revealed that both mMRC dyspnea and SGRQ Total score were significantly associated with waitlist mortality (p = 0.003 and p < 0.001, respectively) as well as age, interstitial lung disease, arterial partial pressure of carbon dioxide, and forced vital capacity. Multivariable competing risk analyses revealed that the mMRC and SGRQ score were associated with waitlist mortality in addition to age and interstitial lung disease.
Both mMRC dyspnea and SGRQ score were significantly associated with waitlist mortality, in addition to other clinical variables such as patients' background, underlying disease, and pulmonary function. Patient-reported dyspnea and health may be measured through multi-dimensional analysis (including subjective perceptions) and for risk stratification regarding waitlist mortality.
由于供体短缺导致肺移植等待名单上的患者死亡是一个全球性的严重问题。目前，日本的受者选择主要基于登记顺序。因此，迫切需要有关等待名单死亡率的风险分层的科学证据。我们假设患者报告的呼吸困难和健康状况可预测肺移植等待名单上患者的死亡率。
我们分析了与等待名单死亡率相关的因素，使用了 203 名从已故供体中登记为肺移植候选者的数据。呼吸困难使用改良的医学研究委员会（mMRC）呼吸困难量表进行评估，健康状况使用圣乔治呼吸问卷（SGRQ）确定。
在符合纳入标准的 197 名患者中，主要基础疾病为间质性肺疾病（99 例）。在中位数为 572 天的随访期间，72 名患者死亡，96 名患者接受了肺移植（69 例来自已故供体）。单变量竞争风险分析显示，mMRC 呼吸困难和 SGRQ 总分均与等待名单死亡率显著相关（p=0.003 和 p<0.001），此外还有年龄、间质性肺疾病、动脉二氧化碳分压和用力肺活量。多变量竞争风险分析显示，mMRC 和 SGRQ 评分与年龄和间质性肺疾病一起与等待名单死亡率相关。
除了患者背景、基础疾病和肺功能等其他临床变量外，mMRC 呼吸困难和 SGRQ 评分与等待名单死亡率显著相关。患者报告的呼吸困难和健康状况可以通过多维分析（包括主观感知）进行测量，并用于等待名单死亡率的风险分层。
