基于数据库建立老年脓毒症患者急性肾损伤风险预测模型  

An acute kidney injury risk prediction model for elderly patients with sepsis based on the intensive care medicine information database-Ⅳ

作　　者：赵晶晶[1] 陈福进 陈婷[1] 王菁 随秀华 冯含敏 姚莉[1] Zhao Jingjing;Chen Fujin;Chen Ting;Wang Jing;Sui Xiuhua;Feng Hanmin;Yao Li(Department of Critical Care Medicine,The Second People's Hospital of Hefei,Hefei Hospital Affiliated to Anhui Medical University,Hefei 230011,China)

机构地区：[1]合肥市第二人民医院(安徽医科大学附属合肥医院)重症医学科,合肥230011

出　　处：《中华老年医学杂志》2023年第2期169-175,共7页Chinese Journal of Geriatrics

摘　　要：目的探究老年脓毒症患者48 h快速进展为急性肾损伤(AKI)3期的危险因素,建立相关患者的风险预测模型,并对模型进行评估及外部验证。方法提取重症医学信息数据库(MIMIC-Ⅳv1.0)中所有老年脓毒症患者(年龄≥60岁)的临床数据,通过多因素Logistic回归分析确定患者48 h内进展为AKI3期的独立危险因素,构建风险预测模型,并绘制列线图,采用受试者工作特征曲线(ROC)和Hosmer-Lemeshow(H-L)检验对模型预测准确性及拟合度进行评价。回顾性收集2019年5月至2021年10月入住合肥市第二人民医院的老年脓毒症患者(年龄≥60岁)临床数据纳入验证集,代入预测模型进行外部验证。结果基于MIMIC-Ⅳ数据库,共筛选出1977例老年脓毒症患者纳入训练集,其中544例入科48 h内进展为AKI3期。对可能与老年脓毒症患者肾损伤风险相关的因素进行单因素分析,结果显示与未进展为AKI3期的正常组比较,ICU治疗时间、24 h内静脉液体入量、血管活性药物使用[5(3,9)d比7(4,12)d;2.05(1.17,3.27)ml·kg^(-1)·h^(-1)比2.37(1.47,4.10)ml·kg^(-1)·h^(-1);761(53.11%)比375(68.93%),均P<0.001]等28个指标之间差异有统计学意义。进一步根据多因素Logistic回归分析,最终以白蛋白(OR=0.983,95%CI:0.966~0.999,P=0.040)、天门冬氨酸氨基转移酶(AST)(OR=1.000,95%CI:1.000~1.000,P<0.001)、活化部分凝血活酶时间(APTT)(OR=1.005,95%CI:1.001~1.009,P=0.028)、总胆红素(OR=1.003,95%CI:1.001~1.004,P=0.001)、血肌酐(OR=1.005,95%CI:1.004~1.007,P<0.001)、查尔森合并症指数(Charlson)评分(OR=1.117,95%CI:1.061~1.177,P<0.001)、24 h静脉入量(OR=1.101,95%CI:1.034~1.173,P=0.003)、体重(OR=1.023,95%CI:1.018~1.029,P<0.001)、机械通气(OR=2.412,95%CI:1.843~3.157,P<0.001)共9项指标构建预测模型。预测模型ROC曲线下面积(AUC)为0.755(95%CI:0.731~0.780),H-L检验,χ^(2)=10.89,P=0.208,模型拟合度良好。验证集共纳入102例老年脓毒症患者,27例患者在入科48 h内进展Objective To explore the risk factors of acute kidney injury(stage 3)developed within 48 hours in elderly patients with sepsis,and to use them to develop a risk prediction model and then evaluate and externally validate the model.Methods Clinical data of all elderly patients(age≥60 years)with sepsis in the intensive care medicine information database(MIMIC-Ⅳv1.0)were extracted.Independent risk factors were determined by multivariate logistic regression analysis.A risk prediction model was constructed,a nomogram was drawn,and the receiver operating characteristic curve(ROC)and the Hosmer-Lemeshow(H-L)test were used to evaluate the model's prediction accuracy and R-squared.Clinical data of elderly patients(age≥60 years)with sepsis admitted to the Department of Critical Care Medicine of the Second People's Hospital of Hefei from May 2019 to October 2021 were retrospectively collected and fed into the prediction model to conduct external validation.Results A total of 1977 elderly patients with sepsis were screened out from the MIMIC-IV database and included in the training set,of whom,544 developed AKI-stage 3 within 48 hours.Univariate analysis was performed for factors that might be associated with acute kidney injury in elderly patients with sepsis.Compared with the normal group that did not progress to AKI stage 3,there were statistically significant differences in 28 indicators,such as the duration of ICU stay,intravenous fluid intake in 24 hours,and use of vasoactive drugs[5(3,9)d vs.7(4,12)d;2.05(1.17,3.27)ml·kg^(-1)·h^(-1)vs.2.37(1.47,4.10)ml·kg^(-1)·h^(-1);761(53.11%)vs.375(68.93%),P<0.001].Based on the results of multivariate logistic regression analysis,a prediction model was finally constructed with 9 variables:albumin(OR=0.983,95%CI:0.966-0.999,P=0.040),aspartate transaminase(OR=1.000,95%CI:1.000-1.000,P<0.001),APTT(OR=1.005,95%CI:1.001-1.009,P=0.028),total bilirubin(OR=1.003,95%CI:1.001-1.004,P=0.001),serum creatinine(OR=1.005,95%CI:1.004~1.007,P<0.001),Charlson score(OR=1.117,95%CI:1.061-1.17

关 键 词：老年人 脓毒症 肾损伤 预测模型 

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