AACC2020与KDIGO2012急性肾损伤诊断标准在ICU重症患者人群中的比较研究  

Comparative study on diagnostic criteria AACC2020 and KDIGO2012 for critically ill patients with acute kidney injury in ICU

作　　者：李晶 程姗姗 王毅[1] 杨宏伟[1] 王湛 宗晓龙[2] LI Jing;CHENG Shanshan;WANG Yi;YANG Hongwei;WANG Zhan;ZONG Xiaolong(Clinical Laboratory of Tianjin Hospital,Tianjin 300211;Clinical Laboratory,the 2nd Hospital of Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津市天津医院检验科,天津300211 [2]天津医科大学第二医院检验科,天津300211

出　　处：《临床检验杂志》2022年第7期498-502,共5页Chinese Journal of Clinical Laboratory Science

基　　金：天津市卫生健康科技项目(KJ20092);天津医科大学第二医院青年科研基金(2019ydey28)。

摘　　要：目的比较研究AACC2020和KDIGO20122种急性肾损伤(AKI)诊断标准在ICU重症患者人群中AKI诊断率及其预后价值的差异。方法以2020年1月至2021年8月天津市天津医院ICU收治的成年重症患者为研究对象,通过查询医院信息系统(HIS)和实验室信息系统(LIS)获取资料。分别依据AACC2020和KDIGO2012标准对研究对象在ICU住院7 d内是否发生AKI进行诊断,比较两者在AKI诊断率、诊断时间上的差异,并比较2种标准与临床结局的关联。结果有579例患者纳入研究,年龄(68.8±15.6)岁,男女比为1.6,中位SOFA评分为3分。经KDIGO2012标准诊断AKI 329例(56.8%),AACC2020标准诊断AKI 350例(60.4%),2组比较差异有统计学意义(P<0.001);2种标准均诊断为AKI者318例(54.9%),两组AKI诊断时间比较差异无统计学意义(P=0.854)。以KDIGO2012为参考标准,AACC2020对AKI漏诊率为3.3%(11/329),漏诊病例多为基线sCr水平较低或较高的患者。AKI_(AACC2020)和AKI_(KDIGO2012)对ICU死亡结局具有相当的预测效能,AUC^(ROC)分别为0.613(95%CI:0.572~0.653)和0.628(95%CI:0.587~0.667);Logistic回归分析显示,AKI_(KDIGO2012)与ICU死亡结局关联更强,校正肾脏以外器官功能损伤因素后,OR值为3.249(95%CI:1.311~8.050)。结论在重症患者人群AACC2020标准对AKI的诊断率高于KDIGO2012,但KDIGO2012标准与临床结局关联更强。Objective To determine the incidence of acute kidney injury(AKI)in critically ill patients according to the diagnostic criteria AACC2020 and KDIGO2012 and compare the difference of predictive value.Methods The adult patients admitted to Intensive Care Unit(ICU)of Tianjin Hospital during January 2020 and August 2021 were retrospectively studied.The relevant data were obtained through hospital information system(HIS)and liboratory information system(LIS).The occurrence of AKI within 7 days since ICU admission was identified according to criteria AACC2020 and KDIGO2012 respectively.The difference of AKI incidence and time(day)of AKI diagnosis were determined,and the association of the AKI_(AACC2020) and the AKI_(KDIGO2012) with clinical outcome in ICU was evaluated.Results A total of 579 patients were included in the current study.The average age was(68.8±15.6)years,the ratio of male to female was 1.6,and the median SOFA score was 3.The AKI episodes were identified as 329(56.8%)and 350(60.4%)by KDIGO2012 and AACC2020 criteria respectively and significant difference was determined between the two groups(P<0.001),but no significant difference could be identified in the time of AKI diagnosis(P=0.854).When KDIGO2012 was used as the the reference,the missed diagnosis rate of AACC2020 was 3.3%(11/329).The most missed patients were the patients whose sCr baselines were lower or higher than those of normal populations.In ROC analysis,AKI_(AACC2020) and AKI_(KDIGO2012) showed similar power in predicting ICU mortality,with the AUC^(ROC) of 0.613(95%CI:0.572 to 0.653)and 0.628(95%CI:0.587 to 0.667)respectively.Logistic regression analysis determined a close association between AKIKDIGO2012 and ICU mortality with an Odds ratio(OR)value of 3.249(95%CI:1.311 to 8.050)adjusted by SOFA without renal component.Conclusion The incidence of AKI diagnosed by AACC2020 criteria may be higher than that by KDIGO2012 in critically ill patients,but the diagnosis by KDIGO2012 criteria should be associated with clinical outcome more closely.

关 键 词：急性肾损伤 肌酐 KDIGO标准 AACC标准 重症 比较研究 

分 类 号：R446[医药卫生—诊断学]