The Association Between Serum Dehydroepiandrosterone Sulfate Levels and Mortality Among Elderly Men on Hemodialysis

Hung-Chieh Wu ； Meng-Hsuan Hsieh ； Wei-Jie Wang ； Lin-Chien Lee

《Acta Nephrologica》 34卷4期 (2020/12) Pp. 171-181

https://doi.org/10.6221/AN.202012_34(4).0004

摘要

BACKGROUND: Dehydroepiandrosterone sulfate (DHEA-S) was associated with muscle mass, which was a predictor of death. This study examined whether DHEA-S levels were superior to skeletal muscle mass in predicting mortality. METHODS: We chose elderly men who initiated hemodialysis in Taoyuan General Hospital from June 2014 to June 2019 to be enrolled. Their medical information such as body composition parameters and DHEA-S were assessed at the first trimester of hemodialysis. Their clinical characteristics and biochemical data were reviewed and followed over a 2-year period. Lean tissue mass index (LTI) was defined by lean tissue mass divided by squared height. We stratified study subjects according to tertiles of DHEA-S levels. Adjusted hazard ratios (aHRs) and 95% confidence interval (CI) for mortality and cumulative survival curves were evaluated by the Cox hazards model and Kaplan-Meier method. The discriminative power of LTI and DHEA-S levels were calculated according to the area under the curve and the receiver operating characteristic curve. RESULTS: From a total of 175 men on hemodialysis during the cohort time, 133 elderly men were analyzed. The tertiles of DHEA-S levels were ＜ 30.6 μg/dL, 30.7-62.7 μg/dL, and ＞ 62.8 μg/dL. After multivariable adjustment other than LTI, low DHEA-S levels were a significant predictor for 2-year mortality (aHR [95% CI], 3.55 [1.04-13.32]). The unadjusted and adjusted c-statistics of LTI vs. DHEA-S to predict 2-year survival were 0.697 (0.575-0.820) vs. 0.710 (0.590-0.828) and 0.729 (0.621-0.837) vs. 0.765 (0.659-0.871), whereas the capacity of c-statistics were similar (χ_s^2 ＜ 2.25, Ps ＞ 0.05). CONCLUSION: Compared to LTI, serum DHEA-S levels were not inferior to predict 2-year mortality among elderly men on maintenance hemodialysis.

關鍵字

body composition ； DHEA-S ； hemodialysis ； mortality ； sarcopenia