查尔森合并症指数联合共存疾病指数对血液透析患者预后的评估价值  

Charlson comorbidity index combined with index of coexistence disease score in evaluating prognosis of hemodialysis patients

作　　者：左富姐[1] 鲍恩昊[1] 吴艳芬[1] 王志宏[1] 朱爱国[1] 齐华林 ZUO Fu-jie;BAO En-hao;WU Yan-fen;WANG Zhi-hong;ZHU Ai-guo;QI Hua-lin(Dept.of Nephrology,Shanghai Pudong New Area People's Hospital,Shanghai 201200,China)

机构地区：[1]上海市浦东新区人民医院肾内科,上海201200

出　　处：《同济大学学报（医学版）》2021年第5期622-626,共5页Journal of Tongji University(Medical Science)

基　　金：上海市浦东新区领先人才培养项目(PWRL2019-08)。

摘　　要：目的探讨查尔森合并症指数(Charlson comorbidity index,CCI)联合共存疾病指数(index of coexistent disease,ICED)对血液透析(hemodialysis,HD)患者预后的评估价值。方法单中心、回顾性分析上海市浦东新区人民医院2016年1月—2019年12月间肾内科诊断并收治的HD患者206例。收集其一般人口学资料(性别、年龄、原发病、透龄)、基础疾病情况、血透生存情况等资料,利用上述资料进行CCI、ICED评分。按临床终点分为死亡组和存活组。对比两组的临床特征差异,利用多因素Logistic回归分析影响HD患者预后的独立危险或保护因素。绘制受试者工作特征(ROC)曲线,评估CCI、ICED对血透患者预后的评估价值。结果在206例患者中,存活132例,死亡74例,病死率35.9%。与存活组比较,死亡组患者年龄、男性、糖尿病肾病、CCI、ICED、心血管疾病、感染的比例均较高,但透龄低于存活组。单因素分析显示,年龄、透龄、CCI、ICED、感染、心血管疾病与血透患者死亡预后相关。多因素Logistic回归分析提示,年龄(OR=1.039,95%CI:1.003~1.076,P=0.035)、CCI(OR=1.257,95%CI:1.021~1.546,P=0.031)、ICED(OR=2.463,95%CI:1.443~4.202,P=0.001)、与血透患者死亡预后独立相关。年龄、CCI、ICED及三者合并后预测预后的ROC曲线下面积[AUC(95%CI)]依次为0.768(0.702~0.833)、0.809(0.748~0.870)、0.800(0.737~0.862)、0.851(0.797~0.905).以三者联合预测的AUC最大,说明其预测生存结局的准确率大于任何单项指标,灵敏度为82.43%,特异度为80.30%。结论CCI联合ICED可以较好地评价血透患者的预后。Objective To evaluate the application of Charlson comorbidity index(CCI)combined with index of coexistent disease(ICED)in assessing prognosis of patients with hemodialysis.Methods A total of 206 patients undergoing hemodialysis(HD)in Department of Nephrology of Shanghai Pudong New Area People s Hospital from January 2016 to December 2019 were enrolled.The general demographic data(sex,age,primary disease),underlying disease,hemodialysis and survival were retrospectively collected and the co-existing diseases were evaluated with CCI and ICED.The clinical characteristics of survival group and fatal group were compared,and the factors affecting the prognosis of HD patients were analyzed by univariate and multivariate Logistic regression analysis.The prognostic value of CCI index and ICED score in hemodialysis patients was assessed with ROC curve.Results Among 206 patients,132 survived and 74 died with a fatality rate of 35.9%.The proportion of older age,male gender,diabetic nephropathy,CCI index,ICED score,cardiovascular disease and infection in the fatal group was higher than that in the survival group,but the duration of hemodialysis was lower than that in the survival group.Univariate analysis revealed that age,duration of hemodialysis,CCI index,ICED score,infection,cardiovascular disease were associated with fatal outcomes in hemodialysis patients.Multivariate Logistic regression analysis showed that older age(OR=1.039,95%CI:1.003-1.076,P=0.035),CCI(OR=1.257,95%CI:1.021-1.546,P=0.031),ICED score(OR=2.463,95%CI:1.443-4.202,P=0.001)were independent risk factors for fatal outcome of hemodialysis patients.The area under ROC curve(AUC)of age,CCI index,ICED score and the combination of three indicators in predicting prognosis was 0.768(0.702-0.833),0.809(0.748-0.870),0.800(0.737-0.862)and 0.851(0.797-0.905),respectively.The sensitivity and specificity of the combination of the three predict for predicting the prognosis was 82.43%and 80.30%,respectively.Conclusion CCI index combined with ICED can be effectively used for

关 键 词：查尔森合并症指数 共存疾病指数 血液透析 预后 

分 类 号：R692[医药卫生—泌尿科学]