Zhou Zhirong, Zhang Lin, Zhang Delin, Yang Yan, Ou Shuiping
Department of Pharmacy, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Front Immunol. 2025 Aug 29;16:1574525. doi: 10.3389/fimmu.2025.1574525. eCollection 2025.
The prognosis of kidney transplantation is currently assessed primarily through clinical monitoring, which involves considerable time and financial costs. Estimated plasma volume status (ePVS) has emerged as a straightforward and efficient method for evaluating patient condition. However, the potential prognostic significance of ePVS in kidney transplant recipients has yet to be thoroughly investigated.
The clinical data for the patient were obtained from the MIMIC-IV database. ePVS was calculated based on hematocrit and hemoglobin values upon admission. Baseline characteristics were compared according to ePVS quartiles, and the relationship between ePVS levels and kidney transplant failure (KTF) in patients was assessed using a Logistic regression model.
4,421 eligible subjects (2,584 males and 1,837 females) with an average age of 52.53 ± 13.00 years old were included in our study. 3,661 (82.80%) had no kidney transplant failure (No-KTF) and 760 (17.20%) had kidney transplant failure (KTF). The ePVS values exhibited a skewed distribution, with the admission patients concentrated in the range of 4-8 mL/g and the discharge patients concentrated in the range of 6-10 mL/g. The ePVS level in the KTF group (7.20 [5.78, 8.85]) was significantly higher than that in the non-KTF group (6.12 [4.95, 7.60]) (< 0.001) at admission. The ePVS level in the KTF group (8.18 [6.71, 9.47]) was significantly higher than that in the non-KTF group (7.01 [5.56, 8.55]) (< 0.001) at discharge. The sensitivity values were 0.851 and 0.805, the specificity values were 0.744 and 0.81, and the AUC values were 0.861 and 0.847, respectively, at admission and discharge. In our subgroup analysis, including interactive validation, we found that regardless of admission or discharge, the risk of KTF was greater when ePVS increased in Non-heart failure (HF) (-interaction<0.001).
In this study, we found that higher ePVS values were accompanied by an increase in KTF risk, and this association proved robust and independent of age, gender, and comorbidities. Additionally, in our subgroup analysis, including interactive validation, we found that regardless of admission or discharge, the risk of KTF was greater when ePVS increased in non-heart failure. Therefore, ePVS may be an important reference parameter for kidney transplant patients and help improve risk stratification.
目前肾移植的预后主要通过临床监测来评估，这需要大量的时间和经济成本。估计血浆容量状态（ePVS）已成为一种评估患者状况的直接且有效的方法。然而，ePVS在肾移植受者中的潜在预后意义尚未得到充分研究。
患者的临床数据来自MIMIC-IV数据库。根据入院时的血细胞比容和血红蛋白值计算ePVS。根据ePVS四分位数比较基线特征，并使用逻辑回归模型评估患者中ePVS水平与肾移植失败（KTF）之间的关系。
本研究纳入了4421名符合条件的受试者（男性2584名，女性1837名），平均年龄为52.53±13.00岁。3661名（82.80%）没有肾移植失败（无KTF），760名（17.20%）发生了肾移植失败（KTF）。ePVS值呈偏态分布，入院患者集中在4-8 mL/g范围内，出院患者集中在6-10 mL/g范围内。入院时，KTF组的ePVS水平（7.20[5.78,8.85]）显著高于非KTF组（6.12[4.95,7.60]）（<0.001）。出院时，KTF组的ePVS水平（8.18[6.71,9.47]）显著高于非KTF组（7.01[5.56,8.55]）（<0.001）。入院和出院时的敏感性值分别为0.851和0.805，特异性值分别为0.744和0.81，AUC值分别为0.861和0.847。在我们的亚组分析（包括交互验证）中，我们发现无论入院还是出院，在非心力衰竭（HF）患者中，当ePVS升高时，KTF的风险更大（交互作用<0.001）。
在本研究中，我们发现较高的ePVS值伴随着KTF风险的增加，并且这种关联被证明是稳健的，且独立于年龄、性别和合并症。此外，在我们的亚组分析（包括交互验证）中，我们发现无论入院还是出院，在非心力衰竭患者中，当ePVS升高时，KTF的风险更大。因此，ePVS可能是肾移植患者的一个重要参考参数，并有助于改善风险分层。
