Department of Nephrology and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Centre for Kidney Diseases, Chengdu, China.
Medical Information Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Front Immunol. 2024 May 17;15:1382970. doi: 10.3389/fimmu.2024.1382970. eCollection 2024.
To examine the prognostic values of systemic immune-inflammation indices of hemodialysis (HD) vascular access failure and develop a prediction model for vascular access failure based on the most pertinent systemic immune-inflammation index.
A prospective cohort study.
SETTING & PARTICIPANTS: Patients undergoing autogenous HD vascular access surgeries or arteriovenous graft as a permanent hemodialysis access in a tertiary center in southwest China from January 2020 to June 2022.
Systemic immune-inflammation indices, including NLR, dNLR, AAPR, SIRI, SII, PNI, PLR, and LIPI, and clinical variables.
The outcome was defined as survival of the hemodialysis access, with both occluded and stenotic access being considered as instances of access failure.
Cox proportional hazard regression model.
2690 patients were included in the study population, of whom 658 experienced access failure during the follow-up period. The median duration of survival for HD vascular access was 18 months. The increased systemic immune-inflammation indices, including dNLR, NLR, SII, PNI, SIRI, PLR, and LIPI, are predictive of HD access failure, with SII demonstrating the strongest prognostic value. A simple SII-based prediction model for HD access failure was developed, achieving C-indexes of 0.6314 (95% CI: 0.6249 - 0.6589) and 0.6441 (95% CI: 0.6212 - 0.6670) for predicting 6- and 12-month access survival, respectively.
Systemic immune-inflammation indices are significantly and negatively associated with HD vascular access survival. A simple SII-based prediction model was developed and anticipates further improvement through larger study cohort and validation from diverse centers.
探讨血液透析（HD）血管通路失败的全身免疫炎症指标的预后价值，并基于最相关的全身免疫炎症指标建立血管通路失败预测模型。
前瞻性队列研究。
本研究对象为 2020 年 1 月至 2022 年 6 月在中国西南地区一家三级中心接受自体 HD 血管通路手术或动静脉移植物作为永久性血液透析通路的患者。
全身免疫炎症指标，包括 NLR、dNLR、AAPR、SIRI、SII、PNI、PLR 和 LIPI 以及临床变量。
结局定义为血液透析通路的存活，闭塞和狭窄通路均视为通路失败。
Cox 比例风险回归模型。
共纳入 2690 例患者，其中 658 例在随访期间发生通路失败。HD 血管通路的中位生存时间为 18 个月。升高的全身免疫炎症指标，包括 dNLR、NLR、SII、PNI、SIRI、PLR 和 LIPI，预测 HD 通路失败，其中 SII 具有最强的预后价值。建立了一个基于 SII 的简单 HD 通路失败预测模型，该模型预测 6 个月和 12 个月通路生存的 C 指数分别为 0.6314（95%CI：0.6249-0.6589）和 0.6441（95%CI：0.6212-0.6670）。
全身免疫炎症指标与 HD 血管通路生存显著负相关。建立了一个基于 SII 的简单预测模型，通过更大的研究队列和来自不同中心的验证，预计该模型将进一步得到改善。
