The Surprise Question in Hemodialysis, Frailty, Nutrition, Patient-reported Quality of Life, and All-Cause Mortality: The Osaka Dialysis Complication Study (ODCS)

IF 3.2 Q1 UROLOGY & NEPHROLOGY
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引用次数: 0

Abstract

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.

Study Design

Cohort study.

Setting & Participants

A multicenter study including 994 patients on maintenance hemodialysis in Japan.

Predictors

(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).

Outcomes

All-cause mortality.

Analytical Approach

Cox proportional hazard models.

Results

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.

Limitations

We did not assess the agreement of responses to the SQ between different raters.

Conclusions

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.

Plain Language Summary

“Would I be surprised if this patient died in the next 6 months?” This question posed to a clinician is called the “surprise question” (SQ) and the answer “no” (SQ-No) has been shown to predict a higher risk of mortality in patients undergoing hemodialysis. We examined which domains are intuitively assessed with the SQ, such as frailty, malnutrition, and patient-perceived quality of life in a cohort of hemodialysis patients. We found that the association between the SQ response and mortality was independent of frailty and malnutrition but was closely related to the physical domain of patient-perceived quality of life. The results suggest that the SQ appears to assess the physical domain of patient-perceived health-related quality of life rather than objectively assessed frailty or malnutrition.
血液透析、虚弱、营养、患者报告的生活质量和全因死亡率中的意外问题:大阪透析并发症研究(ODCS)
理由和ampamp; 目标对 "如果透析患者在未来 6 个月内死亡,临床医生是否会感到惊讶 "的惊讶问题(SQ)回答 "不会"(SQ-No)与较高的全因死亡风险有关。目前还不确定 SQ 可以直观地评估哪些领域。我们假设,在一组维持性血液透析患者中,SQ 将评估患者的虚弱、营养不良或患者感知的健康相关生活质量。预测因素(1) 护士回答的 SQ;(2) 根据修改后的心血管健康研究标准评估的虚弱程度;(3) 根据老年营养风险指数 (GNRI) 评估的营养不良程度;(4) 根据 36 项简表健康调查 (SF-36) 身体成分摘要 (PCS) 评估的患者感知的健康相关生活质量。结果全因死亡率。分析方法Cox比例危险模型。结果中位年龄和透析年份分别为66岁和5.9年,35.8%为女性,39.6%患有糖尿病肾病。SQ-No和虚弱的发生率分别为19.7%和45.9%。GNRI 和 SF-36 PCS 评分的中位数分别为 96.3 分和 36.9 分。在 5 年的随访中,有 247 名患者死亡。独立于潜在的混杂因素,SQ-No、体弱、低 GNRI 和低 SF-36 PCS 均可显著预测较高的死亡风险。在进一步调整虚弱程度或 GNRI 后,SQ-No 仍是一个重要的预测因子,但在调整 SF-36 PCS 后,SQ-No 不再重要。护士对 SQ 的回答似乎评估的是患者感知的健康相关生活质量中的生理领域,而不是客观评估的体弱或营养不良。向临床医生提出的这个问题被称为 "惊喜问题"(SQ),答案 "不"(SQ-No)已被证明可预测血液透析患者的较高死亡风险。我们在一组血液透析患者中研究了 SQ 可以直观评估的领域,如虚弱、营养不良和患者感知的生活质量。我们发现,SQ 反应与死亡率之间的关系与虚弱和营养不良无关,但与患者感知的生活质量的物理领域密切相关。结果表明,SQ 似乎是评估患者感知的健康相关生活质量中的身体领域,而不是客观评估的虚弱或营养不良。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Kidney Medicine
Kidney Medicine Medicine-Internal Medicine
CiteScore
4.80
自引率
5.10%
发文量
176
审稿时长
12 weeks
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