International Islamic University (Siddiqa), Islamabad, Pakistan; from the Quaid-i-Azam University (Shabbir), Islamabad, Pakistan; and from the University of Southampton (Kimber), Southampton, United Kingdom.
Saudi Med J. 2021 Jul;42(7):714-720. doi: 10.15537/smj.2021.42.7.20210082.
To develop an externally validated multivariable prognostic model for an underprivileged dialysis population.
This was a multicenter retrospective cohort study of 5 years duration from January 2013 to December 2017. A total of 758 patients (37.5% female; mean±SD age, 44.26±14.77 years) were enrolled for construction of the prognostic model. The data were analyzed using a proportional hazards model to identify predictors of survival. Three risk groups were identified at the 25th and 75th percentiles of the resultant prognostic index. The model was externally validated with another dataset of 622 dialysis patients.
The prognostic index included 5 predictor variables: hemoglobin, serum potassium, interdialytic weight gain, serum albumin, and duration of dialysis, which had good predictive performance on the calibration and discrimination aspects of the model (Harrell's c statistic: 0.748, Gonen and Heller k statistic: 0.647, Somers' D statistic: 0.496, calibration slope: 1.156). There were significant interaction effects between weight and hemoglobin, weight and albumin, albumin and potassium, and albumin and hemoglobin.
We developed an externally validated model that contained 5 routinely collected prognosticators and confirmed its calibration and discrimination abilities in obtaining reliable prognostic estimates in developing countries. The model will assist clinicians in deciding the prognosis of dialysis patients. The application of this model in different clinical settings of developing countries can indicate interesting findings regarding public health.
为贫困透析人群开发一个经过外部验证的多变量预后模型。
这是一项为期 5 年的多中心回顾性队列研究，时间范围为 2013 年 1 月至 2017 年 12 月。共纳入 758 例患者（37.5%为女性；平均年龄±标准差为 44.26±14.77 岁），用于构建预后模型。使用比例风险模型分析数据以确定生存的预测因素。在预测指数的第 25 和 75 百分位数处确定了 3 个风险组。使用另一个包含 622 例透析患者的数据集对模型进行外部验证。
预后指数包括 5 个预测变量：血红蛋白、血清钾、透析间体重增加、血清白蛋白和透析时间，该模型在模型的校准和区分方面具有良好的预测性能（哈雷尔 c 统计量：0.748、戈嫩和赫勒 k 统计量：0.647、萨默斯 D 统计量：0.496、校准斜率：1.156）。体重和血红蛋白、体重和白蛋白、白蛋白和钾以及白蛋白和血红蛋白之间存在显著的交互作用。
我们开发了一个经过外部验证的模型，其中包含 5 个常规收集的预后指标，并证实其校准和区分能力可在发展中国家获得可靠的预后估计。该模型将有助于临床医生判断透析患者的预后。该模型在发展中国家不同临床环境中的应用可以提供有关公共卫生的有趣发现。
