C 反应蛋白-白蛋白比值与新进入血液透析患者的 6 个月死亡率。

C-reactive protein-to-albumin ratio and six-month mortality in incident hemodialysis patients.

机构信息

Faculdade de Medicina da Universidade de Lisboa, Universidade de Lisboa, Lisboa, Portugal.

Division of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa No Lisboa, Portugal.

出版信息

Ren Fail. 2023 Dec;45(1):2182615. doi: 10.1080/0886022X.2023.2182615.

DOI:10.1080/0886022X.2023.2182615

PMID:36995004

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10064818/

Abstract

BACKGROUND

The first few months of hemodialysis (HD) are associated with a higher risk of mortality. Protein-energy malnutrition is a demonstrated major risk factor for mortality in this population. The C-Reactive Protein to Albumin ratio (CAR) has also been associated with increased mortality risk. The aim of this study was to determine the predictive value of CAR for six-month mortality in incident HD patients.

METHODS

Retrospective analysis of incident HD patients between January 2014 and December 2019. CAR was calculated at the start of HD. We analyzed six-month mortality. A Cox regression was performed to predict six-month mortality and the discriminatory ability of CAR was determined using the receiver operating characteristic (ROC) curve.

RESULTS

A total of 787 patients were analyzed (mean age 68.34 ± 15.5 years and 60.6% male). The 6-month mortality was 13.8% ( = 109). Patients who died were significantly older ( < 0.001), had more cardiovascular disease ( = 0.010), had central venous catheter at the start of HD ( < 0.001), lower parathyroid hormone (PTH) level ( = 0.014) and higher CAR ( = 0.015). The AUC for mortality prediction was 0.706 (95% CI (0.65-0.76), < 0.001). The optimal CAR cutoff was 0.5, HR 5.36 (95% CI 3.21-8.96, < 0.001).

CONCLUSION

We demonstrated that higher CAR was significantly associated with a higher mortality risk in the first six months of HD, highlighting the prognostic importance of malnutrition and inflammation in patients starting chronic HD.

摘要

背景

血液透析（HD）的头几个月与死亡率较高相关。蛋白质能量营养不良是该人群死亡的一个已证实的主要危险因素。C 反应蛋白与白蛋白比值（CAR）也与增加的死亡风险相关。本研究的目的是确定 CAR 对起始 HD 的患者 6 个月死亡率的预测价值。

方法

回顾性分析 2014 年 1 月至 2019 年 12 月期间新开始 HD 的患者。在开始 HD 时计算 CAR。我们分析了 6 个月的死亡率。进行 Cox 回归以预测 6 个月死亡率，并使用接收者操作特征（ROC）曲线确定 CAR 的区分能力。

结果

共分析了 787 例患者（平均年龄 68.34±15.5 岁，60.6%为男性）。6 个月的死亡率为 13.8%（ =109）。死亡患者明显更年长（ <0.001），患有更多心血管疾病（ =0.010），开始 HD 时就有中心静脉导管（ <0.001），甲状旁腺激素（PTH）水平较低（ =0.014），CAR 较高（ =0.015）。死亡率预测的 AUC 为 0.706（95%CI（0.65-0.76）， <0.001）。最佳 CAR 截断值为 0.5，HR 为 5.36（95%CI 3.21-8.96， <0.001）。