低血清间接胆红素水平与维持性血液透析患者全因死亡的关系

Association of low serum indirect bilirubin level with all-cause mortality in maintenance hemodialysis patients

目的探讨血液透析患者低血清间接胆红素(IBIL)水平与全因死亡的关系。方法纳入2015年6月至2016年6月于贵州省7家血液透析中心行维持性血液透析(MHD)治疗3个月以上的成人患者。收集并记录患者人口学资料、稳定透析3个月以上的临床及实验室检查作为基线数据。根据基线血清IBIL水平四分位数将所有患者分为4组(Q1~Q4组),并随访至2018年6月30日。采用Kaplan-Meier法比较各组患者生存率,Cox回归模型分析IBIL与全因死亡的相关性。结果共885例具有基线IBIL数据的血液透析患者被纳入研究,年龄(55.4±16.2)岁,其中男512例(57.9%),IBIL水平为4.8(3.3,7.0)μmol/L。四组间糖尿病患者比例、血红蛋白、血清白蛋白、血小板、血钙、丙氨酸转氨酶、血尿酸和血尿素氮水平差异均有统计学意义(均P<0.05)。经过中位24个月的随访,210例患者死亡,96例失访。Kaplan-Meier生存曲线显示Q1组(基线血清IBIL≤3.3 μmol/L)患者生存率较低(P=0.015)。经性别、年龄、合并症及生化指标等校正后,以Q2组(IBIL 3.4~4.8 μmol/L)为参照,基线血清IBIL≤3.3 μmol/L的患者全因死亡的风险比为1.661(95%CI:1.114~2.476,P=0.013)。Kaplan-Meier生存曲线显示,按血清总胆红素或直接胆红素四分位数分组,比较各组间全因死亡率差异均无统计学意义(P=0.167、0.156)。结论血液透析患者基线低血清IBIL水平与全因死亡相关。

Objective To investigate the association of low serum indirect bilirubin (IBIL) level with all-cause mortality in maintenance hemodialysis (MHD) patients. Methods A multicenter retrospective cohort study was conducted in seven hemodialysis centers of Guizhou province. The adult outpatients who underwent hemodialysis for more than 3 months were included between June 2015 and June 2016. Demographics, baseline clinical and laboratory test results were collected. Patients were divided into 4 groups according to their baseline serum IBIL levels (interquartile range), and followed up until June 30, 2018. Kaplan-Meier method was used to compare the survival rate of each group. Cox regression model was used to analyze the association of IBIL with all-cause mortality. Results A total of 885 hemodialysis dialysis patients with baseline IBIL data were enrolled in this study, with age of (55.4±16.2) years old, among whom 57.9%(512/885) were male. Median IBIL was 4.8 μmol/L and interquartile range was 3.3-7.0 μmol/L. The comparison between IBIL quartile groups showed that the differences in proportion of diabetics, hemoglobin, serum albumin, platelet, serum calcium, alanine aminotransferase (ALT), uric acid and urea nitrogen were statistically significant (all P<0.05). After a median follow-up of 24 months, 210 patients died, and 96 cases became lost to follow-up. Kaplan-Meier curves showed higher all-cause mortality in patients with IBIL≤3.3 μmol/L (Q1 group)(65/219, P=0.015). After adjusting for age, gender, comorbidities, and biochemical indicators, taking baseline IBIL Q2 level (IBIL 3.4~4.8 μmol/L) as a reference, the hazard ratio for all-cause death in patients with IBIL≤3.3 μmol/L was 1.661 (95%CI: 1.114-2.476, P=0.013). Kaplan-Meier survival curve showed that there was no significant difference in mortality between the quartile groups according to total bilirubin (TBIL) or direct bilirubin (DBIL)(P=0.167, 0.156). Conclusion Baseline low serum IBIL in maintenance hemodialysis patients is associated with all-cause mortality.