Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Renal Medicine, Aarhus University Hospital, Aarhus , Denmark.
Am J Med. 2022 May;135(5):615-625.e9. doi: 10.1016/j.amjmed.2021.11.018. Epub 2021 Dec 31.
Although venous thromboembolism is a well-known complication of nephrotic syndrome, the long-term absolute and relative risks of arterial thromboembolism, venous thromboembolism, and bleeding in adults with nephrotic syndrome remain unclarified.
In this matched cohort study, we identified every adult with first-time recorded nephrotic syndrome from admissions, outpatient clinics, or emergency department visits in Denmark during 1995-2018. Each patient was matched by age and sex with 10 individuals from the general population. We estimated the 10-year cumulative risks of recorded arterial thromboembolism, venous thromboembolism, and bleeding accounting for the competing risk of death. Using Cox models, we computed crude and adjusted hazard ratios (HRs) of the outcomes in patients with nephrotic syndrome versus comparators.
Among 3967 adults with first-time nephrotic syndrome, the 1-year risk of arterial thromboembolism was 4.2% (95% confidence interval [CI] 3.6-4.8), of venous thromboembolism was 2.8% (95% CI 2.3-3.3), and of bleeding was 5.2% (95% CI 4.5-5.9). The 10-year risk of arterial thromboembolism was 14.0% (95% CI 12.8-15.2), of venous thromboembolism 7.7% (95% CI 6.8-8.6), and of bleeding 17.0% (95% CI 15.7-18.3), with highest risks of ischemic stroke (8.1%), myocardial infarction (6.0%), and gastrointestinal bleeding (8.2%). During the first year, patients with nephrotic syndrome had increased rates of both arterial thromboembolism (adjusted HR [HR] = 3.11 [95% CI 2.60-3.73]), venous thromboembolism (HR = 7.11 [5.49-9.19]), and bleeding (HR = 4.02 [3.40-4.75]) compared with the general population comparators after adjusting for confounders.
Adults with nephrotic syndrome have a high risk of arterial thromboembolism, venous thromboembolism, and bleeding compared with the general population. The mechanisms and consequences of this needs to be clarified.
尽管静脉血栓栓塞症是肾病综合征的一种已知并发症，但成人肾病综合征患者发生动脉血栓栓塞症、静脉血栓栓塞症和出血的长期绝对和相对风险仍不清楚。
在这项匹配队列研究中，我们从丹麦的入院、门诊或急诊就诊中确定了每一位首次记录为肾病综合征的成人患者。每位患者都按照年龄和性别与普通人群中的 10 人进行了匹配。我们估计了记录的动脉血栓栓塞症、静脉血栓栓塞症和出血的 10 年累积风险，同时考虑了死亡的竞争风险。使用 Cox 模型，我们计算了肾病综合征患者与对照组相比的结局的粗和调整后的危险比（HR）。
在 3967 名首次患有肾病综合征的成人中，1 年的动脉血栓栓塞症风险为 4.2%（95%置信区间[CI] 3.6-4.8），静脉血栓栓塞症风险为 2.8%（95% CI 2.3-3.3），出血风险为 5.2%（95% CI 4.5-5.9）。10 年的动脉血栓栓塞症风险为 14.0%（95% CI 12.8-15.2），静脉血栓栓塞症风险为 7.7%（95% CI 6.8-8.6），出血风险为 17.0%（95% CI 15.7-18.3），其中缺血性中风（8.1%）、心肌梗死（6.0%）和胃肠道出血（8.2%）的风险最高。在最初的一年中，与普通人群对照者相比，肾病综合征患者的动脉血栓栓塞症（调整后的 HR [HR] = 3.11 [95% CI 2.60-3.73]）、静脉血栓栓塞症（HR = 7.11 [5.49-9.19]）和出血（HR = 4.02 [3.40-4.75]）的发生率均升高，在调整混杂因素后。
与普通人群相比，成人肾病综合征患者发生动脉血栓栓塞症、静脉血栓栓塞症和出血的风险较高。需要阐明其发生的机制和后果。
