RESUMO
It is important for the dialysis specialist to provide essential and safe care to hemodialysis (HD) patients. However, little is known about the actual effect of dialysis specialist care on the survival of HD patients. We therefore investigated the influence of dialysis specialist care on patient mortality in a nationwide Korean dialysis cohort. Methods: We used an HD quality assessment and National Health Insurance Service claims data from October to December 2015. A total of 34,408 patients were divided into two groups according to the proportion of dialysis specialists in their HD unit, as follows: 0%, no dialysis specialist care group, and ≥50%, dialysis specialist care group. We analyzed the mortality risk of these groups using the Cox proportional hazards model after matching propensity scores. Results: After propensity score matching, 18,344 patients were enrolled. The ratio of patients from the groups with and without dialysis specialist care was 86.7% to 13.3%. The dialysis specialist care group showed a shorter dialysis vintage, higher levels of hemoglobin, higher single-pool Kt/V values, lower levels of phosphorus, and lower systolic and diastolic blood pressures than the no dialysis specialist care group. After adjusting demographic and clinical parameters, the absence of dialysis specialist care was a significant independent risk factor for all-cause mortality (hazard ratio, 1.10; 95% confidence interval, 1.03–1.18; p = 0.004). Conclusion: Dialysis specialist care is an important determinant of overall patient survival among HD patients. Appropriate care given by dialysis specialists may improve clinical outcomes of patients undergoing HD.
RESUMO
Many countries have their own hemodialysis (HD) quality assurance programs and star rating systems for HD facilities. However, the effects of HD quality assurance programs on patient mortality are not well understood. Therefore, in the present study, the effects of the Korean HD facility star rating on patient mortality in maintenance HD patients were evaluated. Methods: This longitudinal, observational cohort study included 35,271 patients receiving HD treatment from 741 facilities. The fivestar ratings of HD facilities were determined based on HD quality assessment data from 2015, which includes 12 quality measures in structural, procedural, and outcome domains. The patients were grouped into high (three to five stars) and low (one or two stars) groups based on HD facility star rating. Cox proportional hazards model was used to evaluate the effects of star rating on patient mortality during the mean follow-up duration of 3 years. Results: The patient ratio between high and low HD facility star rating groups was 82.0% vs. 18.0%. The patients in the low star rating group showed lower single-pool Kt/V and higher calcium and phosphorus levels compared with subjects in the high star rating group. After adjusting for sociodemographic and clinical parameters, the HD facility star rating independently increased the mortality risk (hazard ratio, 1.11; 95% confidence interval, 1.04–1.18; p = 0.002). Conclusion: The HD facilities with low star rating showed higher patient mortality.
RESUMO
We investigated clinical outcome of asymptomatic coronavirus disease 2019 (COVID-19) and identified risk factors associated with high patient mortality using Korean nationwide public database of 5,621 hospitalized patients. The mortality rate and admission rate to intensive care unit were compared between asymptomatic and symptomatic patients. The prediction model for patient mortality was developed through risk factor analysis among asymptomatic patients. The prevalence of asymptomatic COVID-19 infection was 25.8%. The mortality rates were not different between groups (3.3% vs. 4.5%, p=0.17). However, symptomatic patients were more likely to receive ICU care compared to asymptomatic patients (4.1% vs. 1.0%, p<0.0001). The age-adjusted Charlson comorbidity index score (CCIS) was the most potent predictor for patient mortality in asymptomatic patients. The clinicians should predict the risk of death by evaluating age and comorbidities but not the presence of symptoms. Article Summary LineSince asymptomatic patients have similar mortality rate with symptomatic patients, the clinicians should not classify clinical severity according to initial presence of symptom.
RESUMO
Aged population with comorbidities demonstrated high mortality rate and severe clinical outcome in the patients with coronavirus disease 2019 (COVID-19). However, whether age-adjusted Charlson comorbidity index score (CCIS) predict fatal outcomes remains uncertain. This retrospective, nationwide cohort study was performed to evaluate patient mortality and clinical outcome according to CCIS among the hospitalized patients with COVID-19 infection. We included 5,621 patients who had been discharged from isolation or had died from COVID-19 by April 30, 2020. The primary outcome was composites of death, admission to intensive care unit (ICU), use of mechanical ventilator or extracorporeal membrane oxygenation. The secondary outcome was mortality. Multivariate Cox proportional hazard model was used to evaluate CCIS as the independent risk factor for death. Among 5,621 patients, the high CCIS ([≥]3) group showed higher proportion of elderly population and lower plasma hemoglobin and lower lymphocyte and platelet counts. The high CCIS group was an independent risk factor for composite outcome (HR 3.63, 95% CI 2.45-5.37, P < 0.001) and patient mortality (HR 22.96, 95% CI 7.20-73.24, P < 0.001). The nomogram demonstrated that the CCIS was the most potent predictive factor for patient mortality. The predictive nomogram using CCIS for the hospitalized patients with COVID-19 may help clinicians to triage the high-risk population and to concentrate limited resources to manage them.
