术前排除国际标准化比值的终末期肝病模型评分对心脏术后急性肾损伤行连续性肾脏替代治疗的预测价值  

Predictive value of preoperative MELD-XI score in continuous renal replacement therapy for postoperative acute kidney injury

作　　者：张倩倩[1] 秦藜韦 于欢 李树杰 王伟[1] ZHANG Qian-qian;QIN Li-wei;YU Huan;Li Shu-jie;WANG Wei(The ICU of Teda International Cardiovascular Hospital,Tianjin 300459,China)

机构地区：[1]天津大学泰达国际心血管病医院ICU,天津市300457

出　　处：《中国心血管病研究》2024年第10期923-928,共6页Chinese Journal of Cardiovascular Research

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-019A);泰达国际心血管病医院院级课题(2022-TD-006)。

摘　　要：目的分析术前排除国际标准化比值的终末期肝病模型(MELD-XI)评分与成人心脏手术相关急性肾损伤(CAS-AKI)行连续性肾脏替代治疗(CRRT)的相关关系。方法回顾性收集泰达国际心血管病医院2017年6月至2023年6月期间体外循环下行心脏外科术后发生CSA-AKI的患者351例,根据是否行连续性肾脏替代治疗(CRRT)治疗分为CRRT治疗组和保守治疗组。基于倾向性匹配法对两组进行1∶1匹配。单因素分析两组差异,多因素logistic回归分析CAS-AKI行CRRT治疗的危险因素,ROC曲线下面积评价预测效能。结果共74例行CRRT患者,匹配出74对患者。经倾向性匹配后,两组年龄、性别、体重指数(BMI)、吸烟史、饮酒史、糖尿病史、高血压史均无差异。单因素分析显示,两组在MELD-XI评分、EuroSCORE评分、术前尿酸、术前尿素、术前中性粒/白细胞比值(NLR)、手术时间、体外循环(CPB)时间、主动脉阻断时间、术中钾离子、术中乳酸、心功能NYHA分级>Ⅲ级、围术期应用IABP上差异有统计学意义。纳入多元logistic回归分析后显示,术前MELD-XI评分高(OR=1.176,95%CI 1.009~1.371,P=0.039),EuroSCORE评分高(OR=1.670,95%CI 1.274~2.190,P<0.001)是CSA-AKI行CRRT治疗的独立危险因素。MELD-XI评分和EuroSCORE评分的最佳截断值分别为10.7分和5.5分,ROC曲线下面积分别为0.727和0.832,两者联合预测的曲线下面积为0.921。结论术前MELD-XI评分高和EuroSCORE评分高是CSA-AKI行CRRT治疗的独立危险因素,均具有一定的预测价值,两者联合预测价值优于单一指标。术前MELD-XI评分>10.7分,EuroSCORE评分>5.5分时应引起临床注意。Objective To analyze the correlation between the preoperative model for end-stage liver disease excluding international normalized ratio(MELD-XI)score and continuous renal replacement therapy(CRRT)in adult patients with acute kidney injury(CAS-AKI)after cardiac surgery.Methods A total of 351 patients with CSA-AKI after cardiac surgery under cardiopulmonary bypass in TEDA International Cardiovascular Hospital from June 2017 to June 2023 were retrospectively collected.According to whether CRRT was performed,the patients were divided into CRRT group and conservative treatment group.The two groups were matched 1∶1 based on propensity score matching.Univariate analysis was used to compare the differences between the two groups,multivariate logistic regression analysis was used to analyze the risk factors of CAS-AKI treated with CRRT,and the area under the ROC curve was used to evaluate the predictive efficacy.Results A total of 74 patients underwent CRRT,and 74 pairs of patients were matched.After propensity score matching,there were no significant differences in age,gender,BMI,smoking history,drinking history,diabetes history,and hypertension history between the two groups.Univariate analysis showed that there were significant differences between the two groups in MELD-XI score,EuroSCORE score,preoperative uric acid,preoperative urea,preoperative neutrophil/white blood cell ratio(NLR),operation time,CPB time,aortic cross-clamping time,intraoperative potassium ion,intraoperative lactic acid,NYHA class>Ⅲ,and perioperative IABP application.Into multiple logistic regression analysis showed that after preoperative MELD-XI high score(OR=1.176,95%CI 1.009-1.371,P=0.039),EuroSCORE scoring high(OR=1.670,95%CI 1.274-2.190,P<0.001)were independent risk factors for CRRT in patients with CSA-AKI.The best cut-off values of MELD-XI score and EuroSCORE score were 10.7 and 5.5,respectively.The area under the ROC curve was 0.727 and 0.832,respectively.Conclusions High preoperative MELD-XI score and high preoperative EuroSCORE scor

关 键 词：心脏手术 急性肾损伤 排除国际标准化比值的终末期肝病模型评分 连续性肾脏替代治疗 EuroSCORE评分 

分 类 号：R654.2[医药卫生—外科学]