中老年重症急性胰腺炎患者合并急性肾损伤预测模型的建立与验证  

Establishment and validation of prediction model for severe acute pancreatitis combined with acute kidney injury in middle-aged and elderly patients

作　　者：李文贺 冯程程 张浩 LI Wenhe;FENG Chengcheng;ZHANG Hao(Department of Critical Care Medicine,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院重症医学科,黑龙江哈尔滨150001

出　　处：《胃肠病学和肝病学杂志》2025年第4期488-492,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：黑龙江省卫生健康委科研课题(2020-106)。

摘　　要：目的初步建立中老年重症急性胰腺炎(severe acute pancreatitis,SAP)患者合并急性肾损伤(acute kidney injury,AKI)的预测模型,并对其性能进行评价。方法回顾性分析2020年1月至2023年10月哈尔滨医科大学附属第一医院重症医学科诊治的276例SAP患者的临床资料,根据住院期间是否发生AKI,分为AKI组(n=64,23.19%)和非AKI组(n=212,76.81%)。采用多因素Logistic回归法筛选SAP患者住院期间发生AKI的危险因素,并据此构建预测模型,进一步采用ROC曲线对模型的区分度进行评价。结果多因素Logistic回归分析显示,糖尿病(OR=1.404,95%CI:1.049~1.878)、中心静脉压(OR=1.650,95%CI:1.220~2.233)、改良CT严重指数(OR=1.966,95%CI:1.375~2.811)、IL-6(OR=1.480,95%CI:1.102~1.988)、乳酸(OR=1.573,95%CI:1.161~2.131)是SAP患者住院期间发生AKI的独立危险因素。根据多因素Logistic回归分析筛选的参数,建立SAP患者住院期间发生AKI的预测模型。经验证,模型预测发生AKI的AUC为0.879(95%CI:0.827~0.931),敏感度为84.37%,特异度为80.66%,准确率为81.52%。结论糖尿病、中心静脉压、改良CT严重指数、IL-6、乳酸是SAP患者住院期间合并AKI的独立危险因素,据此构建的模型对于AKI的预测具有良好的性能。Objective To establish a preliminary prediction model for acute kidney injury(AKI)in middle-aged and elderly patients with severe acute pancreatitis(SAP)and evaluate its performance.AKI in middle-aged and elderly patients with SAP and evaluate its performance.Methods The linical datas of 276 SAP patients diagnosed and treated in the Department of Critical Care Medicine of the First Affiliated Hospital of Harbin Medical University from Jan.2020 to Oct.2023 were retrospectively analyzed,and were divided into AKI group(n=64,23.19%)and non-AKI group(n=212,76.81%)according to whether AKI occurred during hospitalisation.Multifactor Logistic regression was used to screen the risk factors for the occurrence of AKI during hospitalisation in SAP patients,and a prediction model was constructed accordingly,and the differentiation of the model was further evaluated by using ROC curves. Results Multifactorial Logistic regression analysis showed that diabetes mellitus(OR=1.404,95%CI:1.049-1.878),central venous pressure(OR=1.650,95%CI:1.220-2.233),modified CT severity index(OR=1.966,95%CI:1.375-2.811),IL-6(OR=1.480,95%CI:1.102-1.988)and lactate(OR=1.573,95%CI:1.161-2.131)were independent risk factors for AKI during hospitalisation in SAP patients.Based on the parameters screened by multifactorial logistic regression analysis,a prediction model for the occurrence of AKI during hospitalisation in SAP patients was developed.The model was validated to predict AKI with an AUC of 0.879(95%CI:0.827-0.931)for raw AKI,a sensitivity of 84.37%,a specificity of 80.66%and an accuracy of 81.52%. Conclusion Diabetes mellitus,central venous pressure,modified CT severity index,IL-6,and lactate are independent risk factors for combined AKI during hospitalisation in SAP patients,and the model constructed accordingly has good performance for the prediction of AKI.

关 键 词：重症急性胰腺炎 急性肾损伤 预测模型 中老年 

分 类 号：R576[医药卫生—消化系统]