乙型肝炎病毒相关慢加急性肝衰竭合并急性肾损伤预测模型的初步构建  

Preliminary construction of a prediction model for HBV-related acute-on-chronic liver failure combined with acute kidney injury

作　　者：刘春晖 戴力维 于海涛[1] LIU Chunhui;DAI Liwei;YU Haitao(Department of Critical Care Medicine,The First Affiliated Hospital of Harbin Medical University,Harbin,Heilongjiang 150000,China)

机构地区：[1]哈尔滨医科大学附属第一医院重症医学科,黑龙江哈尔滨150000

出　　处：《中国临床研究》2024年第5期751-755,共5页Chinese Journal of Clinical Research

基　　金：黑龙江省自然科学基金(D201232)。

摘　　要：目的建立可预测老年乙型肝炎病毒(HBV)相关慢加急性肝衰竭(HBV-ACLF)患者发生急性肾损伤(AKI)的模型,并对模型的性能进行初步评价。方法回顾性纳入2020年1月至2023年1月哈尔滨医科大学附属第一医院住院治疗的276例HBV-ACLF患者,根据住院期间是否发生AKI,分为AKI组72例(26.09%),非AKI组204例(73.91%)。提取所有患者的临床资料,采用多因素logistic回归法筛选HBV-ACLF患者住院期间发生AKI的独立危险因素,并据此构建预测模型,继而采用ROC曲线对预测模型的效能进行评定。结果多因素logistic回归分析结果显示,年龄>70岁(OR=1.404,95%CI:1.134~1.737)、降钙素原>1 ng/L(OR=1.473,95%CI:1.074~2.019)、终末期肝病模型(MELD)评分>34分(OR=1.702,95%CI:1.254~2.311)、上消化道出血(OR=1.516,95%CI:1.123~2.047)是HBV-ACLF患者住院期间发生AKI的独立危险因素(P<0.05)。基于上述4项参数建立HBV-ACLF患者住院期间发生AKI的预测模型,ROC曲线显示模型的AUC为0.882(95%CI:0.838~0.917),灵敏度为66.67%,特异度为93.14%,准确度为86.23%。结论年龄大、MELD评分和降钙素原高、合并上消化道出血是HBV-ACLF患者住院期间发生AKI的独立危险因素,据此构建的模型可预测AKI发生风险,从而辅助临床进行疾病管理。Objective To establish a model that can predict the occurrence of acute kidney injury(AKI)in elderly patients with HBV-related acute-on-chronic liver failure(HBV-ACLF),and to conduct a preliminary evaluation of the performance of the model.Methods A total of 276 patients with HBV-ACLF hospitalised in The First Affiliated Hospital of Harbin Medical University from January 2020 to January 2023 were retrospectively included and divided into 72(26.09%)in the AKI group and 204(73.91%)in the non-AKI group,according to whether AKI occurred during hospitalisation.The clinical data of all patients were extracted and screened for independent risk factors for AKI during hospitalisation using multivariate logistic regression.A prediction model was constructed accordingly,and then the efficacy of the prediction model was evaluated using ROC curves.Results Multivariate logistic regression analysis showed that age>70 years(OR=1.404,95%CI:1.134-1.737),procalcitonin>1 ng/L(OR=1.473,95%CI:1.074-2.019),model for end-stage liver disease(MELD)score>34(OR=1.702,95%CI:1.254-2.311),and combined upper gastrointestinal bleeding(OR=1.516,95%CI:1.123-2.047)were independent risk factors for the occurrence of AKI in HBV-ACLF patients during hospitalisation(P<0.05).A prediction model for the occurrence of AKI in HBV-ACLF patients during hospitalisation was established based on the above four parameters,and the ROC curve showed that the AUC predicted by the model was 0.882(95%CI:0.838-0.917),with a sensitivity of 66.67%,a specificity of 93.14%and an accuracy of 86.23%.Conclusion Elderly,high MELD score and procalcitonin level,and concomitant upper gastrointestinal bleeding are independent risk factors for AKI in patients with HBV-ACLF during hospitalisation,and the model constructed accordingly can predict the risk of AKI,thus assisting clinical disease management.

关 键 词：慢加急性肝衰竭 急性肾损伤 降钙素原 老年 终末期肝病模型评分 上消化道出血 乙型肝炎病毒 

分 类 号：R575.3[医药卫生—消化系统]