急性肾损伤危险评分对脓毒症患者死亡风险的预测价值  

The predictive value of AKI risk score for mortality risk in the patients with sepsis

作　　者：汪文文 袁嫄 汪跃国 王玉兰 孙健[2] 徐军[3] 金魁 Wang Wenwen;Yuan Yuan;Wang Yueguo;Wang Yulan;Sun Jian;Xu Jun;Jin Kui(Graduate School of Bengbu Medical University,Bengbu 233000,China)

机构地区：[1]蚌埠医科大学研究生院,安徽蚌埠233000 [2]中国科学技术大学附属第一医院急诊医学科(急诊ICU),安徽合肥236000 [3]中国医学科学院北京协和医院急诊科,北京100730

出　　处：《中国急救医学》2024年第4期298-304,共7页Chinese Journal of Critical Care Medicine

基　　金：安徽省自然科学基金项目(2208085MH235)。

摘　　要：目的探讨AKI risk评分(基质金属蛋白酶-2×胰岛素样生长因子-7,TIMP-2×IGFBP-7)对急诊脓毒症患者死亡风险的预测价值。方法前瞻性观察2021年9月至2022年12月中国科学技术大学附属第一医院及北京协和医院急诊科收住的脓毒症患者,分别测量患者入院时和入院后6 h的AKI risk评分并计算其变化值(AKI risk-gap),利用多因素Logistic回归、Cox回归、受试者工作特征(ROC)曲线及曲线下面积(AUC)分析AKI risk评分对患者院内死亡风险的预测效能;亚组分析中根据患者是否罹患AKI进一步分析AKI risk评分与不同亚组(AKI组和非AKI组)患者预后的关系。结果本研究共纳入患者202例,住院期间死亡87例(43%)。ROC曲线显示,6 h AKI risk评分预测脓毒症患者院内死亡最为准确,其AUC为0.71(95%CI 0.63~0.78)。亚组分析中AKI组患者6 h AKI risk评分预测院内死亡的AUC为0.76(95%CI 0.65~0.85),非AKI组AUC为0.63(95%CI 0.52~0.73)。多因素Logistic回归和Cox回归分析表明,6 h AKI risk评分和AKI risk-gap是患者院内死亡的独立危险因素。结论AKI risk评分对脓毒症患者院内死亡风险有较好的预测价值,尤其6 h AKI risk评分在罹患AKI的亚组患者中预测价值最高,可为临床区分高危患者并给予相应治疗提供参考。Objective To investigate the predictive value of AKI risk score[tissue inhibitor of metalloproteinase-2(TIMP-2)×insulin-like growth factor binding protein-7(IGFBP-7)levels]for mortality risk in critically ill patients.Methods A prospective observational study was conducted.The patients diagnosed with sepsis were admitted to the emergency departments of the First Affiliated Hospital of the University of Science and Technology of China and Peking Union Medical College Hospital from September 2021 to December 2022.Multivariate Logistic regression,Cox regression models,receiver operating characteristic(ROC)curve and area under ROC curve(AUC)were used to evaluate the predictive efficacy of the AKI risk score for in-hospital mortality risk.Subgroup analysis was conducted to evaluate the predictive value of the AKI risk score in the prognosis of different subgroups(AKI group and non-AKI group)patients based on whether the patient developed AKI.Results Data of 202 patients was available for this study,of which 87 patients(43%)died during hospitalization.ROC of 6 h AKI risk score for predicting in-hospital mortality was 0.71(95%CI 0.63-0.78).Subgroup analysis showed that the AUC for predicting in-hospital mortality in the AKI group based on 6 h AKI risk score was 0.76(95%CI 0.65-0.85),while it was 0.63(95%CI 0.52-0.73)in the non-AKI group.Moreover,multivariable Logistic and Cox regression models indicated that the 6 h AKI risk score and AKI risk-gap were independent risk factors for in-hospital mortality.Conclusions The AKI risk score is a novel and reliable indicator to predict in-hospital mortality of patients with sepsis,especially 6 h AKI risk score for the patients with AKI,providing a reference for clinical differentiation of high-risk patients and appropriate treatment.

关 键 词：脓毒症 急性肾损伤 AKI risk评分(TIMP-2×IGFBP-7) 生物标志物 风险预测 

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