多发伤患者合并急性肾损伤的危险因素及其预测模型构建与效能评估  

Construction and performance evaluation of a prediction model for risk factors of acute kidney injury in patients with multiple trauma

作　　者：张登奎 苗振军[1] 梁亚鹏[1] 周峰[1] 尹其翔[1] 蔡华忠[1] Zhang Dengkui;Miao Zhenjun;Liang Yapeng;Zhou Feng;Yin Qixiang;Cai Huazhong(Department of Emergency,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China)

机构地区：[1]江苏大学附属医院急诊中心,镇江212001

出　　处：《中华创伤杂志》2025年第2期177-187,共11页Chinese Journal of Trauma

基　　金：镇江市科技计划(社会发展)项目(SH2024043)。

摘　　要：目的筛选多发伤患者合并急性肾损伤(AKI)的危险因素,构建多发伤患者合并AKI的预测模型并评估其预测效能。方法采用回顾性队列研究分析2017年1月至2023年6月江苏大学附属医院收治的560例多发伤患者的临床资料,其中男424例,女136例;年龄18~91岁[(55.5±15.0)岁]。将患者按照7∶3随机分为训练集(392例)和验证集(168例)。其中,训练集77例患者合并AKI,验证集33例患者合并AKI。比较训练集AKI组和非AKI组性别、年龄、高血压、糖尿病、致伤原因、头颈部损伤简明损伤定级标准(AIS)评分、颌面部损伤AIS评分、胸部损伤AIS评分、腹部损伤AIS评分、四肢及骨盆损伤AIS评分、体表损伤AIS评分、收缩压、舒张压、心率、呼吸频率、体温、入院24 h内输注红细胞量及血浆量、急诊手术、机械通气、血管活性药物治疗、入院时格拉斯哥昏迷评分(GCS)、入院时修正创伤评分(RTS)、入院时急性生理与慢性健康状况评估Ⅱ(APACHEⅡ)评分、入院时损伤严重度评分(ISS)和入院时实验室检查结果,包括白细胞计数、中性粒细胞计数、淋巴细胞计数、C⁃反应蛋白、血红蛋白、血小板计数、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、凝血酶时间(TT)、国际标准化比值(INR)、D⁃二聚体、血乳酸、碱剩余、总胆红素、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、白蛋白、球蛋白、尿素氮、血肌酐、血糖、血钾、血钠及血氯。在训练集中,采用单因素分析及Lasso回归分析筛选影响多发伤患者合并AKI的危险因素,将筛选出的危险因素纳入多因素Logistic回归分析确定其独立危险因素,然后应用R语言基于上述独立危险因素构建列线图预测模型。采用Hosmer⁃Lemeshow(H⁃L)拟合优度检验评估预测模型在训练集和验证集中的拟合程度,并分别绘制训练集和验证集的受试者工作特征(ROC)�Objective To screen the risk factors of acute kidney injury(AKI)in patients with multiple trauma,construct a prediction model accordingly,and evaluate its predictive value.Methods A retrospective cohort study was performed to analyze the clinical data of 560 multiple trauma patients who were admitted to while Affiliated Hospital of Jiangsu University from January 2017 to June 2023,including 424 males and 136 females,aged 18⁃91 years[(55.5±15.0)years].The patients were randomly divided into a training set(n=392)and validation set(n=168)with a ratio of 7∶3.Of all,77 patients were combined with AKI in the training set,while 33 patients combined with AKI in the validation set.The AKI group and non⁃AKI group in the training set were compared in terms of gender,age,hypertension,diabetes,cause of injury,abbreviated injury scale(AIS)score of head and neck injury,AIS score of maxillofacial injury,AIS score of chest injury,AIS score of abdominal injury,AIS score of extremities and pelvic injury,AIS score of body surface injury,systolic blood pressure,diastolic blood pressure,heart rate,respiratory rate,body temperature,red blood cell and plasma transfusion volume within 24 hours following admission,emergency surgery,mechanical ventilation,vasoactive drug therapy,Glasgow coma score(GCS)on admission,revised trauma score(RTS)on admission,acute physiology and chronic health assessment II(APACHE II)on admission,injury severity score(ISS)on admission,and laboratory test results on admission including white blood cell count,neutrophil count,lymphocyte count,C⁃reactive protein,hemoglobin,platelet count,activated partial thromboplastin time(APTT),prothrombin(PT),fibrinogen(FIB),thrombin time(TT),international normalized ratio(INR),D⁃dimer,blood lactate,base excess,total bilirubin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin,globulin,urea nitrogen,serum creatinine,blood glucose,potassium,sodium and chloronium.In the training set,univariate analysis and Lasso regression analysis were used to screen

关 键 词：多处创伤 乳酸 危险因素 列线图 急性肾损伤 

分 类 号：R264[医药卫生—中医外科学]