Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
PLoS One. 2022 Aug 29;17(8):e0273662. doi: 10.1371/journal.pone.0273662. eCollection 2022.
Serum alkaline phosphatase (ALP) levels are related to high-turnover bone disease and reflect vascular calcification and inflammation. ALP has been reported to have a prognostic impact in various cohorts including chronic kidney disease. This study investigated whether preoperative serum ALP level could be used for predicting mortality in patients undergoing kidney transplantation. We retrospectively reviewed 1,718 patients who underwent kidney transplantation between November 2005 and June 2017. Finally, 1,533 patients who met the inclusion criteria were classified into tertiles based on preoperative serum ALP level (< 51, 51-72, > 72 IU/L). The incidence of mortality was compared among the three tertiles, and a stepwise logistic regression analysis was performed to evaluate the predictors for mortality. The incidence of 3-year mortality was the highest in the third tertile (1.0% vs. 2.5% vs. 4.4% in the first, second, and third tertile, respectively, p = 0.003). The third tertile of ALP level (odds ratio [OR] 1.855, 95% CI 1.192-2.886, p = 0.006), age (OR 1.052, 95% CI 1.022-1.082, p = 0.011), and history of hypertension (OR 0.401, 95% CI 0.210-0.765, p = 0.006) remained as independent predictors of mortality. Preoperative serum ALP level was significantly higher in the non-survivor group than in the survivor group (58.00 [44.00-76.00] vs. 75.00 [56.25-113.00], p = 0.003). The optimal cut-off value of serum ALP to predict 3-year mortality was 71 IU/L (area under the curve 0.636, 95% CI 0.554-0.719, p = 0.003). Therefore, preoperative serum ALP level was an independent predictor of 3-year mortality in patients undergoing kidney transplantation.
血清碱性磷酸酶（ALP）水平与高转换性骨病有关，反映血管钙化和炎症。已有报道称，ALP 在包括慢性肾脏病在内的各种队列中具有预后影响。本研究旨在探讨术前血清 ALP 水平是否可用于预测接受肾移植患者的死亡率。我们回顾性分析了 2005 年 11 月至 2017 年 6 月期间接受肾移植的 1718 例患者。最终，根据术前血清 ALP 水平（<51、51-72、>72IU/L）将符合纳入标准的 1533 例患者分为三分位组。比较三组间死亡率的差异，并进行逐步逻辑回归分析以评估死亡率的预测因素。第三分位组 3 年死亡率最高（第 1、2、3 分位组分别为 1.0%、2.5%、4.4%，p=0.003）。ALP 水平的第三分位组（比值比[OR]1.855，95%置信区间[CI]1.192-2.886，p=0.006）、年龄（OR 1.052，95%CI1.022-1.082，p=0.011）和高血压病史（OR 0.401，95%CI0.210-0.765，p=0.006）仍然是死亡率的独立预测因素。与存活组相比，非存活组的术前血清 ALP 水平显著升高（58.00[44.00-76.00]vs.75.00[56.25-113.00]，p=0.003）。预测 3 年死亡率的血清 ALP 的最佳截断值为 71IU/L（曲线下面积 0.636，95%CI0.554-0.719，p=0.003）。因此，术前血清 ALP 水平是肾移植患者 3 年死亡率的独立预测因素。
