CHA2DS2-VASc Score as a Predictor of Cardiovascular and All-Cause Mortality in a Prospective Cohort of Hemodialysis Patients of Predominantly African Ancestry: The PROHEMO.
Gabriel Brayan Gutiérrez-Peredo, Andrea Jimena Gutiérrez-Peredo, Iris Montaño-Castellón, Marinho Marques da Silva Neto, Fernanda Albuquerque da Silva, Marcia Tereza Silva Martins, Cacia Mendes Matos, Jean Michell Correia Monteiro, Pedro Guimarães Silva, Gildete Barreto Lopes, Marcelo Barreto Lopes, Luis Claudio Correia, Roberto Pecoits-Filho, Keith C Norris, Antonio Alberto Lopes, Roberto Pecoits-Filho
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引用次数: 0
Abstract
Background: Patients with chronic kidney disease undergoing maintenance hemodialysis (MHD) have an increased mortality. The CHA2DS2-VASc score, initially used for stroke prediction in atrial fibrillation, is relevant for various cardiovascular conditions. This study evaluates its effectiveness in predicting cardiovascular and all-cause mortality in MHD patients.
Methods: Data are from the "Prospective Study of the Prognosis of Patients on Chronic Hemodialysis" (PROHEMO) in Salvador, Brazil. Patients were divided by CHA2DS2-VASc scores: ≤2 and >2. Cox regression estimated hazard ratios (HR) for death, both unadjusted and adjusted for confounders. We assessed the distribution of each score variable and its association with mortality. A modified CHA2DS2-VASc score was created due to the low percentage of patients over 75 (1.3%) and normotensive (4.6%).
Results: A total of 237 patients (mean age 51.6 years; 57.0% male) were included in the study. There were 55 deaths, 21 from cardiovascular causes. For patients with a CHA2DS2-VASc score >2, the unadjusted hazard of all-cause mortality was doubled (HR = 2.05; 95% CI: 1.20, 3.49) compared to those with a score ≤2, and the risk for cardiovascular deaths was more than threefold (HR = 3.53; 95% CI: 1.46, 8.54). These ratios remained consistent after adjusting for covariates. In the most comprehensive Cox model, the HR for all-cause mortality was 2.43 (95% CI: 1.38, 4.23) and for cardiovascular mortality was 3.52 (95% CI: 1.40, 8.84), similar to results from the modified CHA2DS2-VASc score.
Conclusions: The results support the CHA2DS2-VASc score as a practical tool for identifying MHD patients at higher risk of mortality, especially from cardiovascular causes.
期刊介绍：
''Nephron'' comprises three sections, which are each under the editorship of internationally recognized leaders and served by specialized Associate Editors. Apart from high-quality original research, ''Nephron'' publishes invited reviews/minireviews on up-to-date topics. Papers undergo an innovative and transparent peer review process encompassing a Presentation Report which assesses and summarizes the presentation of the paper in an unbiased and standardized way.
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