合并严重基础疾病的髋部骨折患者急性肾损伤风险因素分析及预测模型建立  

Risk factors analysis and prediction nomogram establishment of acute kidney injury in hip fracture patients with severe underlying diseases

作　　者：李辰[1] 贾岚 臧加成[1] 于树军[1] 毕学青[2] 孟甲[2] 刘洁[3] 王敬博[1] 张银光[1] Li Chen;Jia Lan;Zang Jiacheng;Yu Shujun;Bi Xueqing;Meng Jia;Liu Jie;Wang Jingbo;Zhang Yinguang(Department of Hip Trauma,Tianjin Hospital,Tianjin 300211,China;Department of Kidney Disease and Blood Purification,the Second Hospital of Tianjin Medical University,Tianjin 300211,China;Department of Osteo-internal Medicine,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院创伤髋关节科,天津300211 [2]天津医科大学第二医院肾脏病血液净化中心,天津300211 [3]天津市天津医院骨内科,天津300211

出　　处：《中华骨科杂志》2023年第16期1094-1103,共10页Chinese Journal of Orthopaedics

基　　金：天津市卫生健康科技项目(TJWJ2021QN048、QN20030);国家骨科与运动康复临床医学研究中心创新基金(2021-NCRC-CXJJ-PY-12)。

摘　　要：目的探讨合并严重基础疾病的髋部骨折患者急性肾损伤的风险因素并建立预测模型。方法使用美国重症监护医学信息数据库(Medical Information Mart for Intensive Care,MIMIC)-Ⅳ分析贝斯以色列女执事医疗中心(Beth Israel Deaconess Medical Center,BIDMC)重症监护病房(intensive care unit,ICU)收治的髋部骨折患者的临床信息,记录患者合并症、疾病评分、生命体征和实验室检查、手术方式、有创操作和药物使用情况。参照改善全球肾脏病预后组织(Kidney Disease Improving Global Outcome,KDIGO)指南的急性肾损伤诊断标准,将纳入患者随机分为训练集和验证集。基于logistic回归分析,采用最小绝对收缩和选择算子(least absolute shrinkage and selection operator,LASSO)逻辑回归算法分析入院后急性肾损伤的风险因素,并推算出相应的预测模型。结果共纳入患者474例,其中训练集331例、验证集143例。参照KDIGO指南的急性肾损伤诊断标准,训练集分为急性肾损伤组159例(48%)和非急性肾损伤组172例(52%)。单因素分析显示年龄(t=2.61,P=0.009)、冠心病(χ^(2)=2.08,P=0.038)、心力衰竭(χ^(2)=2.60,P=0.009)、血红蛋白(t=1.89,P=0.059)、血小板(t=1.81,P=0.070)、尿素氮(t=2.83,P=0.005)、血肌酐(t=3.65,P<0.001)、血钠(t=2.55,P=0.011)、血糖(t=2.52,P=0.012)、阴离子间隙(t=3.44,P=0.001)、舒张压(t=2.72,P=0.007)、平均动脉压(t=2.16,P=0.031)、序贯器官衰竭评分(t=3.69,P<0.001)、简化急性生理功能评分Ⅱ(t=2.95,P=0.003)以及呋塞米(χ^(2)=2.03,P=0.042)、万古霉素(χ^(2)=1.70,P=0.089)、血管活性药物(χ^(2)=3.74,P<0.001)以及有创机械通气(χ^(2)=4.81,P<0.001)的使用为髋部骨折患者发生急性肾损伤的相关危险因素。多因素logistic回归分析显示年龄(OR=1.03,P<0.001)、冠心病(OR=2.05,P=0.069)、血红蛋白(OR=0.88,P=0.050)、血肌酐(OR=1.37,P=0.009)、血钠(OR=1.07,P=0.026)、阴离子间隙(OR=1.09,P=0.028)以及血管活性药物(OR=3.Objective To analyze the risk factors of acute kidney injury(AKI)in hip fracture patients with serious underlying diseases and establish a prediction nomogram.MethodsClinical information of hip fracture patients admitted to the intensive care unit(ICU)of Beth Israel Deaconess Medical Center(BIDMC)was analyzed using the Medical Information Mart for Intensive Care(MIMIC)-IV.Patient comorbidities,disease scores,vital signs and laboratory tests,surgical modalities,invasive procedures,and drug use were recorded.According to the diagnostic criteria of AKI in the Kidney Disease Improving Global Outcome(KDIGO)guideline,the enrolled patients were randomly divided into training set and validation set.Based on logistic regression analysis,least absolute shrinkage and selection operator(LASSO)logistic regression algorithm was used to analyze the risk factors of AKI after admission,and the corresponding prediction model was calculated.ResultsA total of 474 patients were enrolled,including 331 in the training set and 143 in the validation set.According to the diagnostic criteria of AKI of KDIGO guidelines,the patients were divided into AKI group(159 cases)and non-AKI group(172 cases).Univariate analysis showed that age(t=2.61,P=0.009),coronary heart disease(χ^(2)=2.08,P=0.038),heart failure(χ^(2)=2.60,P=0.009),hemoglobin(t=1.89,P=0.059),platelets(t=1.81,P=0.070),urea nitrogen(t=2.83,P=0.005),blood creatinine(t=3.65,P<0.001),blood sodium(t=2.55,P=0.011),blood glucose(t=2.52,P=0.012),anion gap(t=3.44,P=0.001),diastolic blood pressure(t=2.72,P=0.007),mean arterial pressure(t=2.16,P=0.031),SOFA score(t=3.69,P<0.001),simplified acute physiological function score II(SAPSII)score(t=2.95,P=0.003),as well as furosemide(χ^(2)=2.03,P=0.042),vancomycin(χ^(2)=1.70,P=0.089),vasoactive medications(χ^(2)=3.74,P<0.001)and use of invasive mechanical ventilation(χ^(2)=4.81,P<0.001)were risk factors associated with the development of AKI in hip fracture patients.Multivariate logistic regression analysis showed that age(OR=1.03,P<0.001),coro

关 键 词：髋骨折 急性肾损伤 危险因素 重症监护病房 预测列线图 

分 类 号：R692[医药卫生—泌尿科学] R683[医药卫生—外科学]