预测脓毒症急性肾损伤短期不良预后列线图的构建  

Establishment of a nomogram for predicting short-term prognosis of sepsis-associated acute kidney injury

作　　者：姜盈盈[1] 陈新国[1] 高仁贤 吕望[1] 卢中秋[2] JIANG Yingying;CHEN Xinguo;GAO Renxian(Department of Emergency Medicine,Third College of Clinical Medicine,Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学第三临床学院(温州市人民医院)急诊医学科,325000 [2]温州医科大学附属第一医院急诊医学中心

出　　处：《浙江医学》2020年第7期679-682,共4页Zhejiang Medical Journal

摘　　要：目的建立个体化预测脓毒症急性肾损伤(SA-AKI)短期不良预后(30d病死)的列线图模型。方法以2016年3月至2019年5月入住急诊重症监护室的318例SA-AKI患者为研究对象,根据30d预后情况分为病死组225例和存活组93例。采用多因素logistic回归分析法筛选SA-AKI患者30d病死的影响因素,建立预测SA-AKI短期不良预后的列线图模型。结果年龄、真菌感染、APACHEⅡ评分、SOFA评分、抗凝血酶-Ⅲ、AKI分期是SA-AKI患者短期不良预后的独立危险因素(均P<0.05);以这些因素为变量建立SA-AKI短期不良预后列线图。对列线图模型进行验证,初始AUC为0.943,经1000次模型内部验证后为0.945,区分度良好;校正曲线提示观察值与预测值的一致性良好。结论基于6个影响因素(年龄、真菌感染、APACHEⅡ评分、SOFA评分、抗凝血酶-Ⅲ、AKI分期)构建的列线图,能较为准确地预测SA-AKI患者短期不良预后发生的风险,有助于尽早采取干预措施,从而改善患者的预后。Objective To develop a nomogram model to predict the short-term prognosis of sepsis-associated acute kidney injury(SA-AKI).Methods Three hundred and eighteen SA-AKI patients admitted in the emergency intensive care unit(EICU)from March 2016 to May 2019 were enrolled in the study.The patients were divided into survival group(n=93)and fatal group(n=225)according to the fatality within 30 days after admission.Multivariate logistic regression analysis were performed to assess the risk factors of 30-day fatality in patients with SA-AKI,and a nomogram for predicting short-term prognosis was developed.Results Logistic regression analysis showed that age,fungal infection,APACHEⅡscore,SOFA score,antithrombin-III and AKI stage were independent risk factors of fatality within 30 days in patients with SA-AKI.A nomogram model was established based on above 6 indicators.The initial concordance index(C-index)of nomogram was 0.943,and C-index of nomogram was 0.945 after 1000 times of internal validation,indicating good discrimination of the model.The consistency of the nomogram was good according to the calibration curves.Conclusion The nomogram based on the six related factors(age,fungal infection,APACHEⅡscore,SOFA score,antithrombin-III and AKI stage)can accurately predict the risk of 30-day death in patients with SA-AKI.

关 键 词：脓毒症 急性肾损伤 危险因素 预后 列线图 

分 类 号：R459.7[医药卫生—急诊医学] R692[医药卫生—治疗学]