血小板变化率联合KDIGO分级对慢性肾脏病合并急性肾损伤CRRT预后的预测价值  

Predictive value of platelet change rate combined with KDIGO classification in the prognosis of chronic kidney disease complicated with acute kidney injury CRRT

作　　者：亢宁苏 崔俊[1] 邱宇翔 王曦 郑露[1] KANG Ningsu;CUI Jun;QIU Yuxiang;WANG Xi;ZHENG Lu(Department of Nephrology,Nantong Third Affiliated Hospital,Nantong University,Nantong Jiangsu 226006,China)

机构地区：[1]南通大学附属南通第三医院肾内科,江苏南通226006

出　　处：《中国急救复苏与灾害医学杂志》2023年第6期780-783,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省自然科学基金(编号:BK20191077);南通市卫健委课题(编号:MB2020035)。

摘　　要：目的探究血小板变化率联合改善全球肾脏病预后组织(KDIGO)分级对(CKD)合并急性肾损伤(AKI)患者连续性肾脏代替治疗(CRRT)预后的预测价值。方法收集2020年1月—2021年4月南通市第三人民医院收治的79例CKD合并AKI患者的临床资料,根据28 d内生存情况分为预后良好组、预后不良组,比较不同预后患者的一般资料、血小板变化率及KDIGO分级情况,采用Logistic回归分析预后不良的影响因素;并根据ROC及AUC分析血小板变化率联合KDIGO分级对患者CRRT预后的预测价值。结果79例CKD合并AKI患者经CRRT后,28 d内生存48例,死亡31例,死亡率为39.24%;预后不良组病程时间、入ICU时血小板低于预后良好组,预后不良组APACHEⅡ评分、血小板变化率、机械通气人数占比、多脏器功能失常综合征(MODS)发生人数占比、KDIGOⅢ级人数占比高于预后良好组(P<0.05);经Logistic回归分析,病程、机械通气情况、MODS发生情况、入ICU时血小板、血小板变化率、APACHEⅡ评分及KDIGO分级为CKD合并AKI患者CRRT预后不良的独立危险因素(P<0.05);经ROC分析显示,血小板变化率、KDIGO分级的ACU值分别为0.797、0.785,联合预测的ACU为0.910。结论血小板变化率、KDIGO分级与CKD合并AKI患者CRRT预后关系密切,二者联合对预后具有一定预测价值。Objective To explore the predictive value of platelet change rate combined with KDIGO classification on the prognosis of continuous renal replacement therapy(CRRT)in patients with chronic kidney disease(CKD)complicated with acute kidney injury(AKI).Methods The clinical data of 79 patients with CKD complicated with AKI admitted to Nantong Third People's Hospital from January 2020 to April 2021 were collected,and they were divided into a good prognosis group and a poor prognosis group according to the survival within 28 days.The general data,platelet change rate and KDIGO classification of patients with different prognosis were compared.Logistic regression was used to analyze the influencing factors of poor prognosis,and the predictive value of platelet change rate combined with KDIGO classification in the prognosis of patients with CRRT was analyzed according to ROC and AUC.Results Among the 79 patients with CKD and AKI who underwent CRRT,48 survived and 31 died within 28 days,with a mortality rate of 39.24%.The duration of disease,and platelet at ICU admission in the poor prognosis group were lower than those in the good prognosis group,the APACHE Ⅱ score,platelet change rate,the proportion of mechanical ventilation,the proportion of MODS occurrence,and the proportion of KDIGO grade Ⅲ patients in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Logistic regression analysis showed that disease duration,mechanical ventilation,MODS occurrence,platelet at ICU admission,platelet change rate,APACHE Ⅱ score and KDIGO classification were independent risk factors for poor prognosis of CRRT in patients with CKD and AKI(P<0.05).The ROC analysis showed that the ACU values of the platelet change rate and KDIGO classification were 0.797 and 0.785,respectively,and the ACU of the joint prediction was 0.910.Conclusion platelet change rate and KDIGO grade are significantly correlated with the prognosis of CRRT in patients with CKD and AKI,and the combination of the two has a certain predict

关 键 词：慢性肾脏病 急性肾损伤 连续性肾脏代替治疗 血小板变化率 KDIGO分级 预后 

分 类 号：R692[医药卫生—泌尿科学]