危重症急性肾损伤患者血清炎症因子与抢救结局的相关性  

The correlation between serum inflammatory factors and rescue outcomes in critically ill patients with acute kidney injury

作　　者：方顺金 周洁 沈健 Fang Shunjin;Zhou Jie;Shen Jian(Intensive Care Unit,Huzhou Third People′s Hospital,Huzhou 313000,China)

机构地区：[1]湖州市第三人民医院重症监护室,浙江湖州313000

出　　处：《中国急救医学》2025年第3期226-231,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨危重症急性肾损伤患者血清炎症因子与抢救结局的相关性。方法以2021年7月至2024年8月就诊于我院老年科的危重症急性肾损伤患者203例作为研究对象,根据患者入院后4周内存活情况分为存活组(n=151)和死亡组(n=52)。对比两组患者一般临床资料、入院时外周血炎症指标及血清炎症因子水平差异。通过单因素及多因素Logistic回归分析评价各炎症相关指标与危重症急性肾损伤患者抢救结局的相关性,并通过受试者工作特征(ROC)曲线及曲线下面积(AUC)分析各危险因素的预测截断值及预测效能,通过决策曲线、校准曲线评价各相关因素联合预测危重症急性肾损伤患者抢救结局的有效性和准确性。结果死亡组患者序贯器官衰竭评分(SOFA)、白细胞介素-6(IL-6)、平均血小板体积/血小板计数比值(MPV/PLT)、中性粒细胞/淋巴细胞比值(NLR)、中性粒细胞/淋巴细胞和血小板比值(N/LPR)和全身免疫炎症指数(SII)均高于存活组(P<0.05)。单因素及多因素Logistic回归分析表明,SOFA评分、IL-6、MPV/PLT、SII与危重症急性肾损伤患者抢救失败具有显著正相关性(P<0.05)。ROC曲线分析表明,SOFA评分、IL-6、MPV/PLT、SII联合预测危重症急性肾损伤患者抢救失败的AUC为0.912(>0.700),具有较好预测价值。校准曲线分析及决策曲线分析显示,该模型预测的校准度和净收益均较高。结论危重症急性肾损伤患者IL-6、MPV/PLT、SII均与抢救结局存在密切相关性,联合SOFA评分可用于辅助预测危重症急性肾损伤患者的抢救结局。Objective To investigate the correlation between serum inflammatory factors and rescue outcomes in critically ill patients with acute kidney injury.Methods The study included 203 cases of critically ill patients with acute kidney injury who were hospitalized in the Geriatrics Department of Huzhou Third People′s Hospital from July 2021 to August 2024 as the research subjects.Based on their survival status within four weeks after admission,they were classified into survival group(n=151)and death group(n=52).A comparative analysis was conducted on the general clinical characteristics,peripheral blood inflammatory markers upon admission and serum inflammatory factor levels between the two groups.Both univariate and multivariate Logistic regression analyses were performed to assess the relationship between inflammatory-related indicators and the rescue outcomes of critically ill patients with acute kidney injury.The receiver operating characteristic(ROC)curve and area under the curve(AUC)were employed to determine the predictive cutoff values and predictive effectiveness of each indicator for risk assessment.Furthermore,decision curve analysis and calibration curve were utilized to assess the predictive accuracy and effectiveness of joint prediction of various related factors for rescue outcomes of critically ill patients with acute kidney injury.Results Sequential organ failure assessment(SOFA),the levels of interleukin-6(IL-6),mean platelet volume/platelet count ratio(MPV/PLT),neutrophil/lymphocyte ratio(NLR),neutrophil/lymphocyte and platelet ratio(N/LPR),and systemic immune-inflammation index(SII)were found to be higher in the death group compared with the survival group(P<0.05).Both univariate and multivariate Logistic regression analyses revealed a positive association of SOFA,IL-6,MPV/PLT and SII levels with the likelihood of rescue failure in critically ill patients with acute kidney injury(P<0.05).The ROC curve analysis demonstrated that the combined use of SOFA,IL-6,MPV/PLT and SII had a predictive power w

关 键 词：危重症 急性肾损伤 白细胞介素-6 平均血小板体积/血小板计数比值 全身免疫炎症指数 抢救结局 预测 

分 类 号：R692.5[医药卫生—泌尿科学]