- 學位論文
利用病患血清肌酸酐檢測值與年齡來適當化一種腎功能的線上篩選方法
Optimizing an Online Screening Approach for Renal Function Estimation with Patient's Serum Creatinine and Age
摘要
摘要 目的: 運用病患的血清肌酸酐檢測值與年齡兩個參數，找到一個可以在線上篩選出eGFR-CG <50 mL/min的慢性腎臟性疾病(CKD)患者，簡便、快速、有效率的篩選條件。 方法： 從97年9月至98年1月止，透過藥品與檢驗值監測系統之連結，收入條件為開立目標抗生素、肌酸酐大於等於1.0 mg/dL的住院病人。以Cockcroft-Gault(CG)公式及簡易版MDRD4公式，求得病患的估算腎絲球過濾速率(eGFR)，利用不同的血清肌酸酐檢測值與年齡兩項條件進行資料的篩選，並分析篩選條件的成效，求得可以篩選出80%以上eGFR-CG<50 mL/min的病人，但eGFR-CG>50 mL/min者被篩選出的比率最低的最佳化條件。 結果： 研究期間共納入7,381筆資料：男性佔全部69%，病患的平均年紀64.9歲，平均體重61.9公斤，平均Scr值為2.0 mg/dL，平均eGFR-CG與eGFR-MDRD4分別為41.9 mL/min及50.1 mL/min/1.73m2。eGFR-CG < 50 mL/min 共4,895筆，以傳統的Scr>1.5 mg/dL作為篩選條件，只能篩選出2,525筆，遺漏2,370筆(48.4%)；以年齡大於65歲作為篩選條件，只能篩選出3,754筆，遺漏1,141筆(23.3%)，隨著篩選年齡及Scr的下降，雖然遺漏率逐漸下降，相對的，腎功能正常者被篩選出的比例也逐漸增高。 可以篩選出80%以上eGFR-CG低於50 mL/min病人的最佳化條件為Scr≧1.1 mg/dL及年齡大於54歲，篩出率為80.9%，而eGFR-CG高於50 mL/min的篩出率23.4%。篩選出80%以上eGFR-MDRD4低於50 mL/min/1.73m2的病人，最佳化條件為Scr≧1.2 mg/dL及年齡大於58歲，篩出率為80.6%，而eGFR-MDRD4高於50 mL/min/1.73m2的篩出率23.0%。 結論： 本研究結果指出若是單獨以Scr>1.5 mg/dL作為腎功能不全的篩選指標的話，將會遺漏掉將近50%的病人。篩選出eGFR-CG低於50 mL/min的慢性腎臟性疾病(CKD)患者，最有效篩選條件是年齡大於54歲及Scr≧1.1 mg/dL。 關鍵字：肌酸酐、腎絲球過濾速率 (GFR)、Cockcroft-Gault (CG)、Modification of Diet in Renal Disease (MDRD)
並列摘要
ABSTRCT Aim: The aim of this study attempted to find an optimal ceiterion which could be used to screen out all possible patient’s whose eGFR was below 50 mL/min. The method was hopefully to screen more than 80% patients whose eGFRs were less than 50 mL/min and the leastof patients whose eGFRs were greater than 50 mL/min. Also this method should be easy to implement into hospital mainframe computer as alertingfunction that could give warningto clinicians when the criterion was met. Methods: We collected all clinical data from September, 2008 to January, 2009 from inpatients population who were using antimicrobials and Scr≧1.0 mg/dL in a hospital. Estimated glomerular filtration rate (e-GFR) was calculated with both Cockcroft-Gault (CG) equation and Modification of Diet in Renal Disease Study Equation (MDRD4). We then set eGFR-CG or eGFR-MDRD4 as the standard indexes to explore the optimal age and Scr for patient’s renal function when patients’s body weights were not available. Results: There were 7,381 patients’ data collected in this study with male patients69%, mean age64.9 years old, mean body weight 61.9 kg, mean eGFR-CG 41.9 mL/min and eGFR-MDRD4 was 50.1 mL/min/1.73m2. There were 4,895 patients whose eGFR-CG was less than 50 mL/min. If we used Scr >1.5mL/min as the cutting-off point, we only screened out 2,525 (51.6%) patients.When we used age older than 65 as the cut-off point, only 3,754 (76.7%) patients would be screened out. However, more than 80% of patients whose eGFR-CG were less than 50 mL/min, If we applied both the age and Scr level as the screening criteria. The optimal cut-off pointwas both patient’s age older than 54 years and patient’s Scr ≧1.1 mg/dL. However the cut-off would be different (i.e., patient’s age was greater than 58 years old and patient’s Scr ≧1.2 mg/dL), when using eGFR-MDRD4 as the standard index. Conclusions: Our study showed that solely using Scr>1.5 mg/dl as the screening index of CKD could be seriously underestimated for almost 50% of patients whose eGFRs were less than 50 mL/min. We finally proposed that using both Age ≧ 54 years and Scr≧1.1 mg/dL would be the most efficient method for screening CKD patients. Key words: Creatinine, Estimated Glomerular Filtration rate (e-GFR), Cockcroft-Gault (CG) Equation, Modification of Diet in Renal Disease Study Equation (MDRD).