基于MIMIC-Ⅲ数据库的糖尿病肾病患者ICU住院期间死亡因素分析  

Risk factors for death and their predictive value on diabetic kidney disease patients in intensive care unit based on MIMIC-Ⅲdatabase

作　　者：张少雷[1] 孙荣青[2] 毛峥嵘[3] 杨宏富[2] 刘东伟[1] 刘章锁[1] Zhang Shaolei;Sun Rongqing;Mao Zhengrong;Yang Hongfu;Liu Dongwei;Liu Zhangsuo(Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan,China;Department of Surgery Intensive Care Unit,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan,China;Department of Intensive Care Unit,the First Affiliated Hospital of Henan University of CM,Zhengzhou 450002,Henan,China)

机构地区：[1]郑州大学第一附属医院肾脏病中心,郑州450052 [2]郑州大学第一附属医院外科ICU,郑州450052 [3]河南中医药大学第一附属医院ICU,郑州450002

出　　处：《中华危重病急救医学》2020年第9期1085-1090,共6页Chinese Critical Care Medicine

基　　金：国家自然科学基金(81970633,81670663,U1604284)。

摘　　要：目的分析糖尿病肾病(DKD)患者重症监护病房(ICU)住院期间预后的影响因素,并分析其预测价值.方法基于最新版美国重症监护医学信息数据库(MIMIC-Ⅲv1.4)中2001年6月至2012年10月共计5万余例患者的住院信息,筛选出DKD患者的数据资料,包括性别、年龄、体重、合并症〔高血压、冠心病、慢性阻塞性肺疾病(COPD)、慢性肾脏病(CKD)〕、序贯器官衰竭评分(SOFA)、ICU住院时间及ICU住院期间是否进行机械通气、使用血管活性药物和肾脏替代治疗(CRRT),是否并发呼吸机相关性肺炎(VAP)、泌尿道感染(UTI)、糖尿病酮症酸中毒(DKA)、急性心肌梗死(AKI)等以及ICU预后,同时收集患者入住ICU首个24 h内血常规和血生化指标的基线值及ICU住院期间的极值.采用多因素Logistic回归分析筛选DKD患者ICU内死亡的危险因素;绘制受试者工作特征曲线(ROC),分析死亡危险因素的预测价值.结果共筛选416例DKD患者,因数据缺失排除20例,最终纳入396例,其中ICU内存活220例,死亡176例.与存活组比较,死亡组患者年龄更大(岁:57.13±13.04比52.61±14.15),合并高血压和CKD的比例更低(11.4%比23.6%,26.7%比41.4%),SOFA评分及血尿素氮(BUN)、血肌酐(SCr)和血K+的基线值更高〔SOFA评分(分):5.86±2.79比4.49±2.56,BUN(mmol/L):18.4±10.0比14.8±9.0,SCr(μmol/L):387.2±382.8比284.6±244.9,K+(mmol/L):4.64±0.99比4.33±0.86〕,ICU住院时间更长〔d:2.65(1.48,5.21)比2.00(1.00,4.00)〕,差异有统计学意义(均P<0.01).进一步分析ICU住院期间主要实验室指标极值显示,死亡组患者白细胞计数(WBC)、BUN和SCr的最大值(max)与最小值(min)以及血K+max均明显高于存活组〔WBCmax(×109/L):17.3±10.3比14.5±7.3,WBCmin(×109/L):7.9±4.1比6.7±2.7,BUNmax(mmol/L):23.8±10.4比18.8±10.2,BUNmin(mmol/L):11.0±6.6比9.3±6.6,SCrmax(μmol/L):459.7±392.5比350.1±294.4,SCrmin(μmol/L):246.6±180.3比206.9±195.4,K+max(mmol/L):5.35±0.93比5.09±0.99〕,血红蛋白最小�Objective To analyze the influencing factors of prognosis of patients with diabetic kidney disease(DKD)in intensive care unit(ICU),and analyze their predictive value.Methods Based on the inpatient information of more than 50000 patients from June 2001 to October 2012 in the latest version of American Intensive Care Medical Information Database(MIMIC-Ⅲv1.4),the data of DKD patients were screened out,including gender,age,body weight,comorbidities[hypertension,coronary heart disease,chronic obstructive pulmonary disease(COPD),chronic kidney disease(CKD)],sequential organ failure assessment(SOFA)score,the length of ICU stay,the incidence of mechanical ventilation,vasoactive drugs and renal replacement therapy during the ICU hospitalization,complications of other diseases[ventilator-associated pneumonia(VAP),urinary tract infection(UTI),diabetic ketoacidosis(DKA),acute myocardial infarction(AKI)]and prognosis of ICU.At the same time,the blood routine and biochemical data of the first 24 hours in ICU and the extremum values during the ICU hospitalization were collected.Multivariate Logistic regression analysis was used to screen the prognostic factors of DKD patients in ICU,and receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of death risk factors.Results 416 DKD patients were screened out,20 patients were excluded due to data missing,and finally 396 patients were enrolled,including 220 survival patients and 176 dead patients.Compared with the survival group,the patients in the death group were older(years old:57.13±13.04 vs.52.61±14.15),with lower rates of hypertension and CKD(11.4%vs.23.6%,26.7%vs.41.4%),higher SOFA scores and baseline values of blood urea nitrogen(BUN),serum creatinine(SCr)and blood K+[SOFA score:5.86±2.79 vs.4.49±2.56,BUN(mmol/L):18.4±10.0 vs.14.8±9.0,SCr(μmol/L):387.2±382.8 vs.284.6±244.9,K+(mmol/L):4.64±0.99 vs.4.33±0.86],and longer ICU stay[days:2.65(1.48,5.21)vs.2.00(1.00,4.00)],and the differences were statistically significant(all P<0.01).Fu

关 键 词：糖尿病肾病 重症监护 预后 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]