基于MIMIC-Ⅲ数据库的重症患者急性肾损伤预后预测模型的建立  

Development of acute kidney injury prognostic model for critically ill patients based on MIMIC-Ⅲdatabase

作　　者：李敏[1] 杨虎勇 杨伟伟 韦宝花 张宇明[1] 谢瑞敏 褚沛[1] Li Min;Yang Huyong;Yang Weiwei;Wei Baohua;Zhang Yuming;Xie Ruimin;Chu Pei(Department of Emergency,Lanzhou University First Hospital,Lanzhou 730000,Gansu,China;Department of Intensive Care Unit,People's Hospital of Linxia State,Linxia 731100,Gansu,China)

机构地区：[1]兰州大学第一医院急诊科,甘肃兰州730000 [2]临夏州人民医院重症医学科,甘肃临夏731100

出　　处：《中华危重病急救医学》2021年第8期949-954,共6页Chinese Critical Care Medicine

基　　金：甘肃省重点人才项目和陇原青年创新创业人才(团队)项目(2019-39-4)。

摘　　要：目的基于美国重症监护医学信息数据库Ⅲ(MIMIC-Ⅲ),探讨重症监护病房(ICU)内影响急性肾损伤(AKI)患者预后的危险因素,并建立AKI预后预测模型。方法根据诊断代码从MIMIC-Ⅲ数据库中筛选年龄≥18岁、首次入ICU且住院记录完整的急性肾衰竭患者(数据库中延用RIFLE诊断标准,本文中诊断表述为AKI)。依据患者出院时生存状态分为存活组和死亡组,分析患者一般资料、基础疾病、损伤因素、发生AKI 24 h内的生命体征及实验室检查、相关干预措施以及预后指标等。采用单因素、多因素Logistic回归分析确定影响AKI患者死亡的危险因素并建立预测模型;用受试者工作特征曲线(ROC曲线)分析该模型对AKI患者预后的预测价值。结果最终纳入4554例AKI患者,死亡862例,病死率为18.93%。对可能与AKI患者死亡相关的因素进行单因素Logistic回归分析,结果显示,年龄、高血压、淋巴瘤、转移癌、万古霉素、阿司匹林、凝血功能异常、心搏骤停、脓毒症或脓毒性休克、有创机械通气、血白细胞计数(WBC)、血小板计数(PLT)、血K+、血尿素氮(BUN)、总胆红素(TBil)、肾脏替代治疗(RRT)、住院时间(LOS)与AKI患者死亡相关〔优势比(OR)和95%可信区间(95%CI)分别为1.002(1.001~1.003)、0.764(0.618~0.819)、1.749(1.112~2.752)、2.606(1.968~3.451)、1.779(1.529~2.071)、0.689(0.563~0.842)、1.871(1.590~2.201)、2.468(1.209~5.036)、2.610(2.226~3.060)、2.154(1.853~2.505)、1.105(1.009~1.021)、0.998(0.997~0.998)、1.132(1.057~1.212)、1.008(1.006~1.011)、1.061(1.049~1.073)、2.142(1.793~2.997)、0.805(0.778~1.113),均P<0.05〕;进一步二元Logistic回归分析显示,淋巴瘤、转移癌、万古霉素、心搏骤停、脓毒症或脓毒性休克、凝血功能异常、有创机械通气、BUN升高、TBil升高、血K+升高或降低、WBC升高为AKI死亡的独立危险因素〔β值分别为0.636、1.005、0.207、0.894、0.787、0.346、0.686、0.006、0.051�Objective To investigate the risk factors affecting the prognosis of patients with acute kidney injury(AKI)in the intensive care unit(ICU)based on the Medical Information Mart for Intensive CareⅢ(MIMIC-Ⅲ)database,and to establish a prognostic model for AKI.Methods Patients(aged≥18 years)with acute renal failure,admitted to the ICU for the first time,and had complete hospital records(the RIFLE diagnostic criteria were used in the database,and the diagnosis was expressed as AKI in this article)were screened from MIMIC-Ⅲdatabase according to diagnostic codes.Patients were divided into two groups based on survival state at discharge,and the general information,underlying diseases,injury factors,vital signs and laboratory indicators within 24 hours after AKI,related intervention and prognostic indicators were analyzed.Univariate and multivariate Logistic regression analysis were used to determine the risk factors affecting mortality in patients with AKI and established a prediction model.The receiver operator characteristic curve(ROC curve)was used to analyze the predictive value of the prediction model for the prognosis of AKI patients.Results There were 4554 patients with AKI included and 862 died,with mortality of 18.93%.Univariate Logistic regression analysis was performed for factors that might be associated with death in AKI patients,and the results showed that age,hypertension,lymphoma,metastatic carcinoma,vancomycin,aspirin,coagulation abnormalities,cardiac arrest,sepsis or septic shock,invasive mechanical ventilation,white blood cell count(WBC),platelet count(PLT),K+,blood urea nitrogen(BUN),total bilirubin(TBil),renal replacement therapy(RRT)and length of stay(LOS)were independent risk factors[odds ratio(OR)and 95%confidence interval(95%CI)were 1.002(1.001-1.003),0.764(0.618-0.819),1.749(1.112-2.752),2.606(1.968-3.451),1.779(1.529-2.071),0.689(0.563-0.842),1.871(1.590-2.201),2.468(1.209-5.036),2.610(2.226-3.060),2.154(1.853-2.505),1.105(1.009-1.021),0.998(0.997-0.998),1.132(1.057-1.212),1.008(1.006-1

关 键 词：急性肾损伤 重症患者 危险因素 预后 预测模型 

分 类 号：R692[医药卫生—泌尿科学]