ICU中新发急性肾损伤首次连续肾脏替代治疗患者死亡的危险因素分析及风险预测模型构建  

Risk factors for the mortality in critically ill patients with new-onset acute kidney injury requiring continuous renal replacement therapy and the establishment of risk prediction model

作　　者：蒋怡佳 席修明[2] 郑爔 贾会苗 郑悦[1] 李文雄[1] Jiang Yi-Jia;Xi Xiu-Ming;Zheng Xi;Jia Hui-Miao;Zheng Yue;Li Wen-Xiong(Department of Surgical Intensive Critical Unit,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院SICU,北京100020 [2]首都医科大学附属复兴医院重症医学科,北京100038

出　　处：《中国急救医学》2022年第5期387-392,共6页Chinese Journal of Critical Care Medicine

基　　金：首都临床诊疗技术研究及示范应用项目(Z191100006619032);首都卫生发展科研专项项目(首发2020-2-1061);首都医科大学附属北京朝阳医院科技创新基金(21kcjj-8)。

摘　　要：目的分析ICU中新发急性肾损伤(AKI)首次连续肾脏替代治疗(CRRT)患者的临床特征和危险因素,并构建患者28 d死亡的风险预测模型。方法回顾性分析一项由全国17家ICU参研的多中心研究(CCCST)的数据库资料,包括新发AKI首次CRRT患者的基本信息、临床数据及CRRT相关信息等,通过Logistic回归筛选出患者28 d死亡的独立危险因素,并通过列线图实现死亡预测模型的可视化。结果共纳入223例新发AKI首次CRRT患者,28 d病死率为52.5%。年龄、急性生理学评分(APS)及合并脓毒症是患者28 d死亡的独立危险因素(年龄:OR=1.031,95%CI 1.013~1.051,P=0.001;APS:OR=1.075,95%CI 1.027~1.124,P=0.006;脓毒症:OR=2.621,95%CI 1.345~5.109,P=0.005)。基于上述三个独立危险因素建立患者28 d死亡的预测模型,ROC曲线下面积为0.790(95%CI 0.730~0.850,P<0.001)。结论高龄、APS评分及合并脓毒症是新发AKI首次CRRT患者28 d死亡的独立危险因素,据此构建预测模型和列线图可以量化患者的死亡风险。Objective To identify clinical features and prognostic factors for 28-day mortality in intensive care unit(ICU)patients with new-onset acute kidney injury(AKI)requiring continuous renal replacement therapy(CRRT),and to construct risk prediction model of death.Methods The data based on CCCST study(a prospective multicenter study performed in 17 Chinese ICUs).Basic information,clinical data,CRRT related information were collected.Logistic regression analysis was performed to determine the risk factors related to 28-day mortality.A nomogram was constructed to realize the visualization of prediction model.Results A total of 223 patients were enrolled,and the 28-day mortality was 52.5%.Age,the acute physiology score(APS),and sepsis were independent risk factors for 28-day mortality in the patients(age:OR=1.031,95%CI 1.013-1.051,P=0.001;APS:OR=1.075,95%CI 1.027-1.124,P=0.006;sepsis:OR=2.621,95%CI 1.345-5.109,P=0.005).Furthermore,a nomogram model was established based on the above three independent predictors.The area under the ROC curve of prediction model was 0.790(95%CI 0.730-0.850,P<0.001).Conclusions Age,APS score and sepsis are risk factors for 28-day mortality in ICU patients with new-onset AKI requiring CRRT.The nomogram prediction model can quantify the risk of 28-day mortality.

关 键 词：急性肾损伤(AKI) 连续肾脏替代治疗(CRRT) 病死率 预后 

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