摘要
Our intent is to examine the predictive role of Charlson comorbidity index （CCI） on mortality of patients with type 2 diabetic nephropathy （DN）. Based on the CCI score, the severity of comorbidity was categorized into three grades： mild, with CCI scores of 1-2; moderate, with CCI scores of 3-4; and severe, with CCI scores 〉5. Factors influencing mortality and differences between groups stratified by CCI were determined by logistical regression analysis and one-way analysis of variance （ANOVA）. The impact of CCI on mortality was assessed by the Kaplan- Meier analysis. A total of 533 patients with type 2 DN were enrolled in this study, all of them had comorbidity （CCI score 〉1）, and 44.7% （238/533） died. The mortality increased with CCI scores： 21.0% （50/238） patients with CCI scores of 1-2, 56.7% （135/238） patients with CCI scores of 3-4, and 22.3% （53/238） patients with CCI scores 〉5. Logistical regression analysis showed that CCI scores, hemoglobin, and serum albumin were the potential predictors of mortality （P〈0.05）. One-way ANOVA analysis showed that DN patients with higher CCI scores had lower levels of hemoglobulin, higher levels of serum creatinine, and higher mortality rates than those with lower CCI scores. The Kaplan-Meier curves showed that survival time decreased when the CCI scores and mortality rates went up. In con- clusion, CCI provides a simple, readily applicable, and valid method for classifying comorbidities and predicting the mortality of type 2 DN. An increased awareness of the potential comorbidities in type 2 DN patients may provide insights into this complicated disease and improve the outcomes by identifying and treating patients earlier and more effectively.
研究目的:探讨Charlson合并症指数(CCI)对2型糖尿病肾病死亡率的预测作用。研究方法:建立2型糖尿病肾病研究队列,根据CCI评分将患者合并症的严重程度分为三度:轻度(CCI1–2分)、中度(CCI 3–4分)、重度(CCI≥5分)。将影响死亡率的因素及按CCI分层后的组间差异指标进行Logistic回归分析及方差分析(ANOVA)。Kaplan-Meier生存曲线分析CCI指数对生存时间及死亡率的影响。重要结论:533例2型糖尿病肾病患者纳入研究。所有患者的CCI评分均大于1,44.7%(238/533)的患者死亡。患者的死亡率随CCI评分增加而增加,CCI 1–2分患者的死亡率为21.0%(50/238),CCI 3–4分患者的死亡率为56.7%(135/238),CCI≥5分患者的死亡率为22.3%(53/238)。Logistic回归分析显示CCI评分、血红蛋白和血浆白蛋白水平是患者死亡率的预测因子(P<0.05)。方差分析结果显示,与CCI评分相对较低的患者相比,CCI评分越高的患者其血红蛋白水平较低,而血清肌酐较高,死亡率也更高。Kaplan-Meier生存曲线显示CCI评分越高的患者生存时间越短。CCI评分是一种简单易行且实用的评估疾病合并症的方法,可用于预测2型糖尿病肾病患者的死亡率。关注2型糖尿病肾病患者的合并症将有利于早期、有效治疗及改善预后。
基金
Project supported by the Science and Technology Research Projects of Sichuan Province(No.2011SZ0215),China
