Derivation and external validation of the SIMPLICITY score as a simple immune-based risk score to predict infection in kidney transplant recipients.

Autor:	Fernández-Ruiz M; Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid, Spain., Seron D; Department of Nephrology, Hospital Universitari Vall d'Hebron, Vall d' Hebron Institut de Recerca (VHIR), Barcelona, Spain., Alonso Á; Department of Nephrology, Complexo Hospitalario Universitario A Coruña, La Coruña, Spain., Lora D; Clinical Research Unit, Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP)., Hernández D; Department of Nephrology, Hospital Universitario 'Carlos Haya', Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain., González E; Department of Nephrology, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid, Spain., Pérez-Sáez MJ; Department of Nephrology, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain., Gómez G; Department of Nephrology, Hospital Universitari 'Son Espases', Palma de Mallorca, Spain., Pallardó-Mateu LM; Department of Nephrology, Hospital Universitario 'Doctor Peset', Valencia, Spain., Jimeno-García L; Department of Nephrology, Hospital Universitario 'Virgen de la Arrixaca', Murcia, Spain., Cofán F; Department of Nephrology and Kidney Transplantation, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain., Gutierrez-Dalmau A; Department of Nephrology, IIS Aragón, Hospital Universitario 'Miguel Servet', Zaragoza, Spain., Ruiz JC; Department of Nephrology, Hospital Universitario 'Marqués de Valdecilla', Instituto de Investigación 'Marqués de Valdecilla' (IDIVAL), Santander, Spain., Ramírez-Puga A; Department of Nephrology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain., Santana Estupiñán R; Department of Nephrology, Hospital Universitario 'Doctor Negrín', Las Palmas de Gran Canaria, Spain., Marcén R; Department of Nephrology, Hospital Universitario 'Ramón y Cajal', Instituto 'Ramón y Cajal' de Investigación Sanitaria (IRYCIS), Madrid, Spain., Portolés JM; Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro 'Segovia de Arana', Madrid, Spain., Muñoz-Cepeda MÁ; Department of Nephrology, Hospital 'Virgen de la Salud', Complejo Hospitalario de Toledo, Toledo, Spain., López-Medrano F; Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid, Spain., San Juan R; Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid, Spain., Andrés A; Department of Nephrology, Hospital Universitario 'Carlos Haya', Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain., Aguado JM; Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid, Spain. Electronic address: jaguadog1@gmail.com.
Jazyk:	angličtina
Zdroj:	Kidney international [Kidney Int] 2020 Oct; Vol. 98 (4), pp. 1031-1043. Date of Electronic Publication: 2020 Jun 12.
DOI:	10.1016/j.kint.2020.04.054
Abstrakt:	Existing approaches for infection risk stratification in kidney transplant recipients are suboptimal. Here, we aimed to develop and validate a weighted score integrating non-pathogen-specific immune parameters and clinical variables to predict the occurrence of post-transplant infectious complications. To this end, we retrospectively analyzed a single-center derivation cohort of 410 patients undergoing kidney transplantation in 2008-2013 in Madrid. Peripheral blood lymphocyte subpopulations, serum immunoglobulin and complement levels were measured at one-month post-transplant. The primary and secondary outcomes were overall and bacterial infection through month six. A point score was derived from a logistic regression model and prospectively applied on a validation cohort of 522 patients undergoing kidney transplantation at 16 centers throughout Spain in 2014-2015. The SIMPLICITY score consisted of the following variables measured at month one after transplantation: C3 level, CD4 + T-cell count, CD8 + T-cell count, IgG level, glomerular filtration rate, recipient age, and infection within the first month. The discrimination capacity in the derivation and validation cohorts was good for overall (areas under the receiver operating curve of 0.774 and 0.730) and bacterial infection (0.767 and 0.734, respectively). The cumulative incidence of overall infection significantly increased across risk categories in the derivation (low-risk 13.7%; intermediate-risk, 35.9%; high-risk 77.6%) and validation datasets (10.2%, 28.9% and 50.4%, respectively). Thus, the SIMPLICITY score, based on easily available immune parameters, allows for stratification of kidney transplant recipients at month one according to their expected risk of subsequent infection. (Copyright © 2020 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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