美国克利夫兰大学急性肾衰竭风险评分系统在我国成人心脏手术患者中的应用  

Validation of Cleveland Clinical Score Predicting Acute Renal Failure after Cardiac Surgery in Chinese Adult Patients

作　　者：王旭冬[1] 车妙琳[2] 谢波[1] 连锋[1] 刘沙[1] 胡振雷[1] 薛松[1] 

机构地区：[1]上海交通大学医学院附属仁济医院心胸外科,上海200025 [2]上海交通大学医学院附属仁济医院肾脏科,上海200025

出　　处：《中国胸心血管外科临床杂志》2012年第3期262-265,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨美国克利夫兰大学急性肾衰竭风险评分系统(the Clinical Score to Predict Acute Renal Failure,简称Cleveland评分系统)预测中国心脏手术患者术后发生急性肾衰竭(ARF)行肾脏替代治疗(RRT)及患者院内死亡的应用价值。方法将2005年1月至2009年12月期间上海交通大学医学院附属仁济医院收治的所有成人心脏手术患者2 153例纳入研究,其中男1 267例,女886例;年龄58.70(18～99)岁。术前按Cleveland评分分值将所有患者分层:0～2分(n=979),3～5分(n=1 116),6～8分(n=54),9～13分(n=4),比较各组间术后发生ARF行RRT的发生率、多器官功能衰竭(MOSF)的发生率及病死率。应用受试者工作特征(ROC)曲线评价该评分预测术后发生ARF行RRT、患者院内死亡的准确性。结果 0～2分、3～5分、6～8分、9～13分组术后发生ARF行RRT的发生率分别为0.92%、1.88%、12.96%和25.00%(χ2=55.635,P=0.000),MOSF发生率分别为1.23%、1.88%、3.70%和25.00%(χ2=16.080,P=0.001),病死率分别为0.92%、4.21%、25.93%和50.00%(χ2=71.470,P=0.000),4组差异均有统计学意义。Cleveland评分预测术后行RRT的ROC曲线下面积(AUC)为0.775[95%CI(0.713,0.837),P=0.000],预测院内死亡AUC为0.764[95%CI(0.711,0.817),P=0.000]。结论 Cleveland评分系统可有效预测中国成人心脏手术后发生ARF需RRT治疗的风险,为及早对高危人群采取有效的预防措施提供依据。Objective To validate the value of Cleveland Clinical Score to predict acute renal failure （ARF） requiring renal replacement therapy （RRT） and in-hospital death in Chinese adult patients after cardiac surgery. Methods A retrospective analysis was conducted for all the patients who underwent cardiac surgery from January 2005 to December 2009 in Renji Hospital of School of Medicine, Shanghai Jiaotong University. A total of 2 153 adult patients, 1 267 males and 886 females, were included. Their age ranged from 18 to 99 years with an average age of 58.70 years. Cleveland Clinical Score was used to predict ARF after cardiac surgery. ARF was defined as the need for RRT. Based on Cleveland Clinical Score, the patients were divided into four risk categories of increasing severity： 0 to 2 point （n=979）, 3 to 5 point （n=1 116）, 6 to 8 point （n=54）, 9 to 13 point （n=4）. The rates of ARF, multiple organ system failure （MOSF）, and mortality were compared among the 4 categories. The predictive accuracy of postoperative ARF and hospital mortality was assessed by area under the receiver operating characteristic curve （AUC-ROC）. Results In the four categories, the rate of postoperative ARF was 0. 92%, 1.88%, 12.96%, and 25.00%, respectively; MOSF rate was 1.23%, 1.88%, 3.70%, and 25.00%, respectively; mortality was 0. 92%, 4. 21%, 25.93%, and 50. 00%, respectively. There was significant dif-ference among the four categories in ARF rate （2,2=55. 635, P=0. 000）, MOSF rate （Х^2=16. 080, P=-0. 001 ）, and mortality （Х^2=71. 470, P=-0. 000）. The AUC-ROC for Cleveland Clinical Score predicting ARF rate and hospital mortality was 0. 775 （95%CI 0. 713 to 0. 837, P=0. 000） and 0. 764 （95%CI, 0. 711 to 0. 817, P=0. 000）, respectively. Conclusion Cleveland Clinical Score can accurately predict postoperative ARF and hospital mortality in a large, unselected Chinese cohort of adult patients after cardiac surgery. It can be used to provide evidence for effective preventive measures for pat

关 键 词：美国克利夫兰大学急性肾衰竭风险评分系统 心脏手术 急性肾衰竭 预测 

分 类 号：R692.5[医药卫生—泌尿科学]