重症多发伤并发AKI的危险因素与模型构建  

Risk factors and model construction of severe multiple injuries complicated with AKI

作　　者：郑开慧 施金存 吴建华 ZHENG Kaihui;SHI Jincun;WU Jianhua(Wenzhou Central Hospital,Zhejiang 325000,China)

机构地区：[1]浙江省温州市中心医院,温州325000

出　　处：《浙江创伤外科》2024年第2期208-210,214,共4页Zhejiang Journal of Traumatic Surgery

摘　　要：目的探讨基于血流动力学指标、临床特征、实验室指标构建重症监护室(ICU)内重症多发伤患者并发急性肾损伤(AKI)的预测模型。方法纳入2018年1月至2023年10月本院收治的ICU内重症多发伤患者98例作为研究对象,根据患者入院后72 h内是否并发AKI情况,分别纳入并发AKI组(31例)、非并发AKI组(67例),回顾性收集患者临床资料。比较并发AKI组和非并发AKI组的血流动力学指标、临床特征、实验室指标,用Logistic回归探索ICU内重症多发伤患者并发AKI的风险因素,并采用受试者工作特征(ROC)曲线评估该模型的预测价值。结果多因素Logistic分析结果,最终筛选出ICU内重症多发伤患者并发AKI的独立危险因素有血清乳酸、PCT水平高(OR=2.344、2.442,P<0.05),eRPP高为保护因素(OR=0.480,P<0.05)。根据ICU内重症多发伤患者并发AKI的Logistic回归结果,采用ROC曲线评估该模型预测价值,结果显示,预测模型预测ICU内重症多发伤患者并发AKI的AUC值为0.863,模型诊断敏感度为80.65%,特异度为73.13%,提示模型区分度较好。采用Hosmer-Lemeshow拟合优度检验显示模型拟合效果较好,Chi-Square=6.486,DF=6,P=0.653。结论ICU内重症多发伤患者并发AKI的危险因素包括血清乳酸、PCT水平高,eRPP高为保护因素,构建预测模型可为预防措施的制定提供依据,最终改善患者预后。Objective To explore the prediction model of acute kidney injury(AKI)in patients with severe multiple injuries in intensive care unit(ICU)based on hemodynamic indexes,clinical characteristics and laboratory indexes.Methods 98 patients with severe multiple injuries in ICU admitted to our hospital from January 2018 to October 2023 were selected as the research object.According to whether the patients were complicated with AKI within 72 hours after admission,they were divided into two groups:the complicated AKI group(31 cases)and the non-complicated AKI group(67 cases),and their clinical data were collected retrospectively.The hemodynamic indexes,clinical characteristics and laboratory indexes of the two groups were compared.Logistic regression was used to explore the risk factors of patients with severe multiple injuries complicated with AKI in ICU,and the predictive value of the model was evaluated by receiver operating characteristic(ROC)curve.Results Stepwise multivariate Logistic analysis showed that the independent risk factors of AKI in ICU patients with severe multiple injuries were high levels of serum lactic acid and PCT(OR=2.344,2.442,P<0.05),and high eRPP was the protective factor(OR=0.480,P<0.05).According to the Logistic regression results of severe multiple trauma patients complicated with AKI in ICU,ROC curve was used to evaluate the predictive value of the model.The results showed that the AUC value of the predictive model for severe multiple trauma patients complicated with AKI in ICU was 0.863,the diagnostic sensitivity of the model was 80.65%,and the specificity was 73.13%,suggesting that the model had good discrimination.Hosmer-Lemeshow goodness-of-fit test shows that the model had a good fitting effect,Chi-Square=6.486,DF=6,P=0.653.Conclusion The risk factors of AKI in ICU patients with severe multiple injuries include high levels of serum lactic acid and PCT,and high eRPP is the protective factor.The construction of prediction model can provide basis for the formulation of preventive measures

关 键 词：重症监护室 多发伤 急性肾损伤 血流动力学 临床特征 

分 类 号：R459.7[医药卫生—急诊医学]