Shoji Tetsuo, Kabata Daijiro, Kimura Seiichi, Nagata Yuki, Mori Katsuhito, Nakatani Shinya, Fujii Hisako, Morioka Tomoaki, Emoto Masanori
Department of Vascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Japan.
Vascular Science Center for Translational Research, Osaka Metropolitan University Graduate School of Medicine, Japan.
Kidney Med. 2024 Oct 11;6(12):100914. doi: 10.1016/j.xkme.2024.100914. eCollection 2024 Dec.
RATIONALE & OBJECTIVE: A response "no" (SQ-No) to the surprise question (SQ) of whether a clinician would be surprised if a dialysis patient died in the next 6 months is associated with a higher risk of all-cause death. It is uncertain what domains are intuitively assessed with the SQ. We hypothesized that the SQ would assess the patient's frailty, malnutrition, or patient-perceived health-related quality of life in a cohort of patients on maintenance hemodialysis.
Cohort study.
SETTING & PARTICIPANTS: A multicenter study including 994 patients on maintenance hemodialysis in Japan.
(1) SQ answered by nurses; (2) frailty by modified Cardiovascular Health Study criteria; (3) malnutrition as evaluated by Geriatric Nutritional Risk Index (GNRI); and (4) patient-perceived health-related quality of life examined by the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS).
All-cause mortality.
Cox proportional hazard models.
Median age and dialysis vintage were 66 and 5.9 years, respectively, 35.8% were women, and 39.6% had diabetic kidney disease. The prevalence of SQ-No and frailty was 19.7% and 45.9%. Median GNRI and SF-36 PCS scores were 96.3 and 36.9, respectively. During the 5-year follow-up, 247 patients died. SQ-No, being frail, low GNRI, and low SF-36 PCS were each significant predictors of a higher risk for mortality independent of potential confounders. SQ-No remained a significant predictor after further adjustment for frailty or GNRI, but SQ-No was no longer significant when adjusted for SF-36 PCS.
We did not assess the agreement of responses to the SQ between different raters.
The predictive ability of the SQ was closely related to SF-36 PCS in hemodialysis patients. Nurses' answer to the SQ appears to assess the physical domain of patient-perceived health-related quality of life rather than objectively assessed frailty or malnutrition.
对于“如果一名透析患者在接下来6个月内死亡，临床医生是否会感到惊讶”这一意外问题（SQ）回答“否”（SQ-No）与全因死亡风险较高相关。目前尚不确定通过SQ直观评估的是哪些领域。我们假设在维持性血液透析患者队列中，SQ会评估患者的虚弱程度、营养不良状况或患者自我感知的健康相关生活质量。
队列研究。
一项多中心研究，纳入了日本994例维持性血液透析患者。
（1）护士回答的SQ；（2）根据改良心血管健康研究标准评估的虚弱程度；（3）通过老年营养风险指数（GNRI）评估的营养不良状况；（4）通过36项简短健康调查（SF-36）身体成分总结（PCS）检查的患者自我感知的健康相关生活质量。
全因死亡率。
Cox比例风险模型。
中位年龄和透析时间分别为66岁和5.9年，35.8%为女性，39.6%患有糖尿病肾病。SQ-No和虚弱的患病率分别为19.7%和45.9%。GNRI和SF-36 PCS评分的中位数分别为96.3和36.9。在5年随访期间，247例患者死亡。SQ-No、虚弱、低GNRI和低SF-36 PCS各自都是独立于潜在混杂因素的较高死亡风险的显著预测因素。在进一步调整虚弱程度或GNRI后，SQ-No仍然是一个显著的预测因素，但在调整SF-36 PCS后，SQ-No不再显著。
我们没有评估不同评估者对SQ回答的一致性。
在血液透析患者中，SQ的预测能力与SF-36 PCS密切相关。护士对SQ的回答似乎评估的是患者自我感知的健康相关生活质量的身体领域，而非客观评估的虚弱程度或营养不良状况。
