心脏病科收治患者中基于不同公式的肾功能及其对预后的影响
Kidney Function According to Different Equations in Patients Admitted to a Cardiology Unit and Impact on Outcome.
作者信息
Malavasi Vincenzo Livio, Valenti Anna Chiara, Ruggerini Sara, Manicardi Marcella, Orlandi Carlotta, Sgreccia Daria, Vitolo Marco, Proietti Marco, Lip Gregory Y H, Boriani Giuseppe
机构信息
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy.
Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy.
出版信息
J Clin Med. 2022 Feb 8;11(3):891. doi: 10.3390/jcm11030891.
BACKGROUND
This paper aims to evaluate the concordance between the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula and alternative equations and to assess their predictive power for all-cause mortality in unselected patients discharged alive from a cardiology ward.
METHODS
We retrospectively included patients admitted to our Cardiology Division independently of their diagnosis. The total population was classified according to Kidney Disease: Improving Global Outcomes (KDIGO) categories, as follows: G1 (estimated glomerular filtration rate (eGFR) ≥90 mL/min/1.73 m); G2 (eGFR 89-60 mL/min/1.73 m); G3a (eGFR 59-45 mL/min/1.73 m); G3b (eGFR 44-30 mL/min/1.73 m); G4 (eGFR 29-15 mL/min/1.73 m); G5 (eGFR <15 mL/min/1.73 m). Cockcroft-Gault (CG), CG adjusted for body surface area (CG-BSA), Modification of Diet in Renal Disease (MDRD), Berlin Initiative Study (BIS-1), and Full Age Spectrum (FAS) equations were also assessed.
RESULTS
A total of 806 patients were included. Good agreement was found between the CKD-EPI formula and CG-BSA, MDRD, BIS-1, and FAS equations. In subjects younger than 65 years or aged ≥85 years, CKD-EPI and MDRD showed the highest agreement (Cohen's kappa (K) 0.881 and 0.588, respectively) while CG showed the lowest. After a median follow-up of 407 days, overall mortality was 8.2%. The risk of death was higher in lower eGFR classes (G3b HR4.35; 95%CI 1.05-17.80; G4 HR7.13; 95%CI 1.63-31.23; G5 HR25.91; 95%CI 6.63-101.21). The discriminant capability of death prediction tested with ROC curves showed the best results for BIS-1 and FAS equations.
CONCLUSION
In our cohort, the concordance between CKD-EPI and other equations decreased with age, with the MDRD formula showing the best agreement in both younger and older patients. Overall, mortality rates increased with the renal function decreasing. In patients aged ≥75 years, the best discriminant capability for death prediction was found for BIS-1 and FAS equations.
背景
本文旨在评估慢性肾脏病流行病学协作组（CKD-EPI）公式与其他替代方程之间的一致性，并评估它们对从心脏病病房存活出院的未选择患者全因死亡率的预测能力。
方法
我们回顾性纳入了入住我院心脏病科的患者，不考虑其诊断情况。根据改善全球肾脏病预后组织（KDIGO）分类标准对总体人群进行分类，如下：G1（估计肾小球滤过率（eGFR）≥90 mL/min/1.73 m²）；G2（eGFR 89 - 60 mL/min/1.73 m²）；G3a（eGFR 59 - 45 mL/min/1.73 m²）；G3b（eGFR 44 - 30 mL/min/1.73 m²）；G4（eGFR 29 - 15 mL/min/1.73 m²）；G5（eGFR <15 mL/min/1.73 m²）。还评估了Cockcroft-Gault（CG）公式、根据体表面积调整的CG公式（CG-BSA）、肾脏病饮食改良（MDRD）公式、柏林倡议研究（BIS-1）公式和全年龄谱（FAS）公式。
结果
共纳入806例患者。CKD-EPI公式与CG-BSA、MDRD、BIS-1和FAS公式之间存在良好的一致性。在年龄小于65岁或年龄≥85岁的受试者中，CKD-EPI和MDRD显示出最高的一致性（Cohen's kappa（K）分别为0.881和0.588），而CG显示出最低的一致性。中位随访407天后，总体死亡率为8.2%。eGFR较低类别（G3b HR 4.35；95%CI 1.05 - 17.80；G4 HR 7.13；95%CI 1.63 - 31.23；G5 HR 25.91；95%CI 6.63 - 101.21）的死亡风险更高。用ROC曲线测试的死亡预测判别能力显示，BIS-1和FAS公式的结果最佳。
结论
在我们的队列中，CKD-EPI与其他方程之间的一致性随年龄降低，MDRD公式在年轻和老年患者中均显示出最佳的一致性。总体而言，死亡率随肾功能下降而增加。在年龄≥75岁的患者中，BIS-1和FAS公式对死亡预测的判别能力最佳。
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