急性胰腺炎合并急性肾损伤患者的预后评估  

Prognostic evaluation of acute pancreatitis complicated with acute renal injury

作　　者：张秋彬 张楠 林清婷 徐军 朱华栋 姜辉 Zhang Qiubin;Zhang Nan;Lin Qingting;Xu Jun;Zhu Huadong;Jiang Hui(Department of Emergency,the Second Affiliated Hospital of Hainan Medical College,Haikou 570100,C,hina;Department of Emergency,State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,,China)

机构地区：[1]海南医学院第二附属医院急诊科,海口570100 [2]中国医学科学院北京协和医学院,北京协和医院急诊科、疑难重症及罕见病国家重点实验室,北京100730

出　　处：《中华危重症医学杂志（电子版）》2023年第5期382-389,共8页Chinese Journal of Critical Care Medicine:Electronic Edition

摘　　要：目的:评估急性胰腺炎(AP)合并急性肾损伤(AKI)患者的短期预后,并建立一个可预测AP合并AKI患者院内死亡风险的模型,探索其预后影响因素。方法:从重症监护医学信息数据库(MIMIC)Ⅳ 0.4中提取AP患者的临床数据。其后采用单因素及多因素logistic回归方法探索影响AP合并AKI患者预后的危险因素,在此基础上构建列线图。通过绘制受试者工作特征(ROC)曲线,判断其准确性。结果:共纳入1 213例AP患者,根据AP患者是否合并AKI,将其分为AKI组(739例)和非AKI组(474例),两组患者院内病死率分别为9.9%(73/739)和2.1%(10/474)。然后根据患者预后情况,将739例AP合并AKI患者分为存活组(666例)和死亡组(73例)。经单因素及多因素logistic回归分析,结果提示年龄[比值比(OR)= 1.033,95%置信区间(CI)(1.004,1.062),P=0.024],入院类型中相对于急诊入院,紧急入院[OR=2.203,95% CI(1.079,4.499),P=0.030]、择期入院[OR=0.134,95%CI(0.050,0.358),P < 0.001],高脂血症[OR=0.241,95%CI(0.124,0.468),P < 0.001],简化急性生理功能评分Ⅱ(SAPSⅡ)[OR=1.038,95%CI(1.014,1.062),P=0.002],碳酸氢盐[OR=0.910,95%CI(0.853,0.970),P=0.004],休克[OR=2.273,95%CI(1.166,4.429),P=0.016]及腹腔间隔室综合征(ACS)[OR=3.873,95%CI(1.173,12.788),P=0.026]为AP合并AKI患者死亡的影响因素。根据影响因素构建预测模型,计算曲线下面积为0.885[95%CI(0.844,0.926),P < 0.001]。结论:AP患者中,合并AKI者病情更严重,病死率明显升高,预后更差。基于年龄、入院类型、高脂血症、SAPSⅡ评分、碳酸氢盐、ACS、休克7项指标构建的列线图,对AP合并AKI患者具有较好的预测性能,有助于临床医生及时识别患者的死亡风险,从而采取更有效的治疗措施。Objective:To explore the short-term prognosis of patients with acute pancreatitis (AP) complicated with acute kidney injury (AKI), and to establish a model that can predict the risk of in-hospital death in these patients so as to explore prognostic factors.Methods:The clinical data of patients with AP were extracted from the medical information mart for intensive care (MIMIC) Ⅳ 0.4. Afterwards, single-factor and multi-factor logistic regression methods were used to explore the risk factors that affect the prognosis of patients with AP combined with AKI. A nomogram was constructed on this basis and a receiver operating characteristic (ROC) curve was drawn to judge its accuracy.Results:Depending on whether they had concomitant AKI, a total of 1 213 patients with AP were included and separated into an AKI group (739 patients) and a non-AKI group (474 patients). The in-hospital mortality for the two groups was 9.9% (73/739) and 2.1% (10/474), respectively. Then, 739 patients with AP and AKI were separated into survival (666 patients) and death (73 patients) groups based on their prognosis. The single-factor and multi-factor logistic regression analysis showed that age [odds ratio (OR)=1.033, 95% confidence interval (CI) (1.004, 1.062), P=0.024], urgent admission [OR=2.203, 95%CI (1.079, 4.499), P=0.030] and selective admission [OR=0.134, 95%CI (0.050, 0.358), P < 0.001] compared with emergent admission, hyperlipidemia [OR=0.241, 95%CI (0.124, 0.468), P < 0.001], simplified acute physiology score Ⅱ (SAPSⅡ) score [OR=1.038, 95%CI (1.014, 1.062), P=0.002], bicarbonate [OR=0.910, 95%CI (0.853, 0.970), P=0.004], shock [OR=2.273, 95%CI (1.166, 4.429), P=0.016], and abdominal compartment syndrome (ACS) [OR=3.873, 95%CI (1.173, 12.788), P=0.026] were influencing factors for in-hospital death in patients with AP complicated with AKI. A predictive model was constructed based on these influencing factors, and the area under the curve (AUC) was calculated to be 0.885 [95%CI (0.844, 0.926), P < 0.001].Conclusions:Among AP p

关 键 词：急性胰腺炎 急性肾损伤 列线图 预后 

分 类 号：R576[医药卫生—消化系统]