HP联合CVVH治疗脓毒症相关急性肾损伤患者预后不良的预测模型构建  

Construction of a predictive model for poor prognosis in patients with sepsis associated acute kidney injury treated with HP combined with CVVH

作　　者：王亚丽 周晋萌 王美霞 姚哲放 赵兰 王彩虹 李小洋 WANG Yali;ZHOU Jinmeng;WANG Meixia;YAO Zhefang;ZHAO Lan;WANG Caihong;LI Xiaoyang(Department of Critical Care Medicine,the First Clinical College of Shanxi Medical University,Taiyuan,Shanxi 030000,China)

机构地区：[1]山西医科大学第一临床医学院重症医学科,山西太原030000

出　　处：《检验医学与临床》2024年第18期2664-2669,共6页Laboratory Medicine and Clinic

基　　金：山西省基础研究计划项目(202203021222376)。

摘　　要：目的构建血液灌流(HP)联合连续性血液滤过(CVVH)治疗脓毒症相关急性肾损伤(SA-AKI)患者预后不良的预测模型。方法选取2020年12月至2023年1月山西医科大学第一临床医学院收治的150例SA-AKI患者作为研究对象,均对其进行HP联合CVVH治疗,观察治疗7 d后临床指标变化情况。根据治疗28 d后患者是否死亡分为预后不良组和预后良好组,比较预后良好组和预后不良组的临床资料。采用LASSO回归初筛SA-AKI患者经HP联合CVVH治疗后预后不良的影响因素,将筛选出的指标作为因变量,采用多因素Logistic回归分析SA-AKI患者HP联合CVVH治疗后预后不良的危险因素,根据结果构建模型并采用受试者工作特征(ROC)曲线分析评估模型的预测价值。结果治疗7 d后SA-AKI患者尿量多于治疗前,血肌酐(Scr)、尿素氮(BUN)水平及入院序贯器官衰竭(SOFA)评分低于治疗前,差异均有统计学意义(P<0.05)。SA-AKI患者进行HP联合CVVH治疗的住院时间为6~28 d,平均(16.79±5.08)d,严重出血事件发生率为10.67%(16/150)。治疗28 d后,预后良好组有103例患者,预后不良组有47例患者,病死率为31.33%(47/150)。两组脓毒症来源、入院SOFA评分、急性肾损伤(AKI)分期、ICU住院时间、可溶性血栓调节蛋白(sTM)、肝素结合蛋白(HBP)、Dickkopf相关蛋白3(DKK3)水平比较,差异均有统计学意义(P<0.05)。LASSO回归分析筛选出5个变量(入院SOFA评分、AKI分期、sTM、HBP、DKK3)进行多因素Logistic回归分析。结果显示,入院SOFA评分、AKI分期、sTM、HBP、DKK3水平升高是SA-AKI患者HP联合CVVH治疗后预后不良的危险因素(P<0.05)。构建模型为Log(P)=1.570×X_(入院SOFA评分)+1.629×X_(AKI分期)+1.324×X_(sTM)+1.541×X_(HBP)+1.449×X_(DKK3)-7.108。ROC曲线分析结果显示,5项指标联合预测SA-AKI患者HP联合CVVH治疗后预后不良的曲线下面积(AUC)为0.936。结论对SA-AKI患者进行HP联合CVVH治疗效果明显,以入院SOFA评分、AKIObjective To construct a prediction model for poor prognosis of patients with sepsis associated acute kidney injury(SA-AKI)treated with hemoperfusion(HP)combined with continuous hemofiltration(CVVH).Methods A total of 150 SA-AKI patients admitted to the First Clinical College of Shanxi Medical University from December 2020 to January 2023 were selected as the study objects,and all of them were treated with HP combined CVVH,and the clinical indicators were observed after 7 days of treatment.According to whether the patients died after 28 days of treatment,they were divided into poor prognosis group and good prognosis group.The clinical data of good prognosis group and poor prognosis group were compared.LASSO regression was used to initially screen the factors of poor prognosis in SA-AKI patients after HP combined CVVH treatment,and the selected indicators were used as dependent variables to analyze the risk factors of poor prognosis in SA-AKI patients after HP combined CVVH treatment.According to the results,a model was constructed and the predictive value of the model was evaluated by receiver operating characteristic(ROC)curve analysis.Results After 7 days of treatment,the urine volume of SA-AKI patients was higher than before treatment,the levels of blood creatinine(Scr),urea nitrogen(BUN)and the score of sequential organ failure(SOFA)on admission were lower than before treatment,and the differences were statistically significant(P<0.05).The hospital stay of SA-AKI patients treated with HP combined CVVH ranged from 6 to 28 days,with a mean of(16.79±5.08)days,and the incidence of severe bleeding events was 10.67%(16/150).After 28 days of treatment,there were 103 patients in the good prognosis group and 47 patients in the poor prognosis group,and the fatality rate was 31.33%(47/150).There were statistically significant differences in the source of sepsis,SOFA score on admission,stage of acute kidney injury(AKI),length of ICU stay,levels of soluble thromboregulatory protein(sTM),heparin binding protein(HBP)and DI

关 键 词：脓毒症相关急性肾损伤 血液灌流 连续性血液滤过 可溶性血栓调节蛋白 Dickkopf相关蛋白3 肝素结合蛋白 

分 类 号：R692.5[医药卫生—泌尿科学] R459.5[医药卫生—外科学]