CHA2DS2-VASc 评分对预测血液透析患者中期临床结局的效用。

Utility of CHA2DS2-VASc Score to Predict Mid-Term Clinical Outcomes in Hemodialysis Patients.

机构信息

Department of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan.

Department of Kidney Disease and Community Medicine, Hiroshima University Hospital, Hiroshima, Japan.

出版信息

Am J Nephrol. 2022;53(2-3):169-175. doi: 10.1159/000522225. Epub 2022 Mar 8.

DOI:10.1159/000522225

PMID:35259747

Abstract

BACKGROUND

The CHA2DS2-VASc score has been widely used to predict stroke in patients with atrial fibrillation (AF). Recently, it was reported that the CHA2DS2-VASc score helps predict cardiovascular disease (CVD) or all-cause mortality in patients with or without AF. However, few reports have examined the association between this score and mortality in hemodialysis (HD) patients.

METHODS

We analyzed 557 consecutive patients who initiated HD at our facilities between February 2005 and October 2017. The CHA2DS2-VASc score was calculated at the time of initiation of HD. Patients were then categorized into three groups according to their CHA2DS2-VASc scores: 0-1 (low), 2-3 (intermediate), and 4-9 (high). Multivariate Cox proportional hazards analysis was used to assess independent risk factors for 3-year all-cause mortality.

RESULTS

During the 3-year follow-up period, 153 (27.5%) patients died (cardiovascular death: n = 88). According to multivariate analysis, serum albumin (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.43-0.85, p = 0.003), creatinine (HR 0.91, 95% CI 0.84-0.99, p = 0.049), and CHA2DS2-VASc score (HR 1.33, 95% CI 1.20-1.46, p < 0.001) were associated with 3-year all-cause mortality. Compared with patients in the low CHA2DS2-VASc score group, those in the intermediate- and high-score groups had a higher risk for all-cause and CVD mortality (all-cause mortality: HR 1.77, 95% CI 1.23-2.55, p = 0.002 and HR 2.94, 95% CI 1.90-4.53, p < 0.001, respectively; CVD mortality: HR 1.82, 95% CI 1.27-2.59, p = 0.001 and HR 2.85, 95% CI 1.88-4.31, p < 0.001, respectively).

CONCLUSION

The CHA2DS2-VASc score is a valuable predictor of 3-year all-cause and CVD mortality in incident HD patients.

摘要

背景

CHA2DS2-VASc 评分已被广泛用于预测伴有心房颤动（AF）的患者的中风。最近有报道称，CHA2DS2-VASc 评分有助于预测伴有或不伴有 AF 的患者的心血管疾病（CVD）或全因死亡率。然而，很少有报道研究该评分与血液透析（HD）患者死亡率之间的关系。

方法

我们分析了 2005 年 2 月至 2017 年 10 月期间在我们机构开始 HD 的 557 例连续患者。在开始 HD 时计算 CHA2DS2-VASc 评分。然后根据 CHA2DS2-VASc 评分将患者分为三组：0-1（低）、2-3（中）和 4-9（高）。使用多变量 Cox 比例风险分析评估 3 年全因死亡率的独立危险因素。

结果

在 3 年的随访期间，有 153 名（27.5%）患者死亡（心血管死亡：n=88）。根据多变量分析，血清白蛋白（风险比[HR]0.60，95%置信区间[CI]0.43-0.85，p=0.003）、肌酐（HR 0.91，95%CI0.84-0.99，p=0.049）和 CHA2DS2-VASc 评分（HR 1.33，95%CI1.20-1.46，p<0.001）与 3 年全因死亡率相关。与低 CHA2DS2-VASc 评分组的患者相比，中高分组患者的全因和 CVD 死亡率更高（全因死亡率：HR1.77，95%CI1.23-2.55，p=0.002 和 HR2.94，95%CI1.90-4.53，p<0.001；CVD 死亡率：HR1.82，95%CI1.27-2.59，p=0.001 和 HR2.85，95%CI1.88-4.31，p<0.001）。