感染性休克并发AKI患者CRRT撤机失败的决策树分析  

Analysis of CRRT withdrawal failure in patients with infectious shock complicating AKI based on decision tree algorithm

作　　者：熊维 廖浩 许文娟 涂艳[1] XIONG Wei;LIAO Hao;XU Wenjuan;TU Yan(Department of Critical Care Medicine,908th Hospital,Joint Logistic Support Force,PLA,Nanchang 330001,Jiangxi,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇八医院重症医学科,江西南昌330001

出　　处：《中国现代医生》2025年第3期22-26,共5页China Modern Doctor

摘　　要：目的基于决策树算法建立感染性休克并发急性肾损伤(acute kidney injury,AKI)患者行连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)后撤机失败的风险预测模型,探讨感染性休克并发AKI患者CRRT撤机失败的影响因素。方法回顾性分析中国人民解放军联勤保障部队第九〇八医院2020年5月至2023年5月收治的感染性休克并发AKI患者220例,根据撤机成功与否分为成功组和失败组,采用单因素和多因素Logistic回归分析筛选感染性休克并发AKI患者CRRT撤机失败的危险因素,纳入入院时C反应蛋白/白蛋白(C-reactive protein/albumin,CRP/ALB)、撤机时感染相关器官功能衰竭评分系统(sepsis-related organ failure assessment,SOFA)评分、急性生理与慢性健康评分系统Ⅱ(acute physiology and chronic health evaluation,APACHEⅡ)评分、CRRT开始时N末端脑利钠肽前体(N-terminal B-type natriuretic peptide,NT-proBNP)水平、平均动脉压(mean arterial pressure,MAP)分级、撤机后尿量、撤机后血肌酐(serum creatinine,Scr)水平构建感染性休克并发AKI患者CRRT撤机失败的决策树模型并验证模型效能。结果41.82%的患者撤机失败;结合单因素、多因素Logistic回归分析显示,撤机时SOFA评分、APACHEⅡ评分、撤机后尿量、撤机后Scr水平、CRRT开始时NT-proBNP水平、MAP分级、入院时CRP/ALB是感染性休克并发AKI患者CRRT撤机失败的独立危险因素(P<0.05)。CRP/ALB升高是感染性休克并发AKI患者CRRT撤机失败最重要的影响因素,其受试者操作特征曲线下面积为0.965。结论入院时CRP/ALB、撤机时SOFA评分、撤机后尿量、撤机后Scr水平、APACHEⅡ评分、MAP分级构建的决策树模型对感染性休克并发AKI患者CRRT撤机失败的预测效能较好,对患者预后评估具有指导作用。Objective To establish a risk prediction model of continuous renal replacement therapy(CRRT)withdrawal failure in patients with infectious shock complicating acute kidney injury(AKI)based on the decision tree algorithm,and to explore the influencing factors of CRRT withdrawal failure in patients with infectious shock complicating AKI.Methods 220 patients with infectious shock complicating AKI admitted to our hospital from May 2020 to May 2023 were retrospectively analyzed,and divided into success group and failure group according to the success or failure of the withdrawal,univariate and multivariate Logistic regression analysis were used to screen risk factors of CRRT withdrawal failure in patients with septic shock complicated with AKI,C-reactive protein/albumin(CRP/ALB)at admission and sepsis-related organ failure assessment(SOFA)score at withdrawal,acute physiology and chronic health evaluation(APACHEⅡ)score,N-terminal B-type natriuretic peptide(NT-proBNP)level at the beginning of CRRT,mean arterial pressure(MAP)grading,urine volume after withdrawal,and serum creatinine(Scr)level after withdrawal were taken into constructing a decision tree model and validating the model efficacy.Results In this study,there were 41.82% of patients failed to withdrawal.Combination of univariate and multivariate Logistic regression analysis showed that SOFA score at withdrawal,APACHEⅡ scores,urine volume after withdrawal,Scr level after withdrawal,NT-proBNP at the beginning of CRRT,and MAP grading,CRP/ALB at the time of admission were an independent risk factor for CRRT withdrawal failure in patients with septic shock complicated with AKI(P<0.05).The results showed that the higher CRP/ALB was the most important influencing factor on the failure of CRRT evacuation in patients with infectious shock complicating AKI,and the area under the receiver operating characteristic curve was 0.965.Conclusion The decision tree model constructed by CRP/ALB at admission,SOFA score at withdrawal,urine volume after withdrawal,Scr level after

关 键 词：感染性休克 急性肾损伤 连续性肾脏替代治疗 撤机 决策树 预测 

分 类 号：R459.5[医药卫生—治疗学] R631[医药卫生—临床医学]