Ou Shih-Hsiang, Liu Yi-Hsueh, Chung Tung-Ling, Huang Jiun-Chi, Wu Pei-Yu, Su Ho-Ming, Chen Szu-Chia
Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan.
J Pers Med. 2021 Jul 13;11(7):657. doi: 10.3390/jpm11070657.
Patients with end-stage renal disease have a higher risk of cardiovascular morbidity and mortality. In this study, we investigated the predictive ability of a combination of cardiothoracic ratio (CTR) and aortic arch calcification (AoAC) for overall and cardiovascular mortality in patients receiving hemodialysis. We also evaluated the predictive power of AoAC and CTR for clinical outcomes. A total of 365 maintenance hemodialysis patients were included, and AoAC and CTR were measured using chest radiography at enrollment. We stratified the patients into four groups according to a median AoAC score of three and CTR of 50%. Multivariable Cox proportional hazards analysis was used to identify the risk factors of mortality. The predictive performance of the model for clinical outcomes was assessed using the χ2 test. Multivariable analysis showed that, compared to the AoAC < 3 and CTR < 50% group, the AoAC ≥ 3 and CTR < 50% group (hazard ratio [HR], 4.576; < 0.001), and AoAC ≥ 3 and CTR ≥ 50% group (HR, 5.912; < 0.001) were significantly associated with increased overall mortality. In addition, the AoAC < 3 and CTR ≥ 50% (HR, 3.806; = 0.017), AoAC ≥ 3 and CTR < 50% (HR, 4.993; = 0.002), and AoAC ≥ 3 and CTR ≥ 50% (HR, 8.614; < 0.001) groups were significantly associated with increased cardiovascular mortality. Furthermore, adding AoAC and CTR to the basic model improved the predictive ability for overall and cardiovascular mortality. The patients who had a high AoAC score and cardiomegaly had the highest overall and cardiovascular mortality among the four groups. Furthermore, adding AoAC and CTR improved the predictive ability for overall and cardiovascular mortality in the hemodialysis patients.
终末期肾病患者发生心血管疾病和死亡的风险更高。在本研究中，我们调查了心胸比率（CTR）和主动脉弓钙化（AoAC）联合检测对接受血液透析患者的全因死亡率和心血管死亡率的预测能力。我们还评估了AoAC和CTR对临床结局的预测效力。共纳入365例维持性血液透析患者，入组时采用胸部X线测量AoAC和CTR。根据AoAC中位数评分3分和CTR 50%将患者分为四组。采用多变量Cox比例风险分析确定死亡的危险因素。使用χ2检验评估模型对临床结局的预测性能。多变量分析显示，与AoAC<3且CTR<50%组相比，AoAC≥3且CTR<50%组（风险比[HR]，4.576；<0.001）以及AoAC≥3且CTR≥50%组（HR，5.912；<0.001）与全因死亡率增加显著相关。此外，AoAC<3且CTR≥50%组（HR，3.806；=0.017）、AoAC≥3且CTR<50%组（HR，4.993；=0.002）以及AoAC≥3且CTR≥50%组（HR，8.614；<0.001）与心血管死亡率增加显著相关。此外，在基础模型中加入AoAC和CTR可提高对全因死亡率和心血管死亡率的预测能力。在四组中，AoAC评分高且有心脏肥大的患者全因死亡率和心血管死亡率最高。此外，加入AoAC和CTR可提高血液透析患者全因死亡率和心血管死亡率的预测能力。
