探讨CAR、NLR对脓毒症患者并发AKI的预测价值  

Exploring the Predictive Value of CAR and NLR in Patients with Sepsis Complicated with AKI

作　　者：林明江 邢柏[1] 童丽珍 

机构地区：[1]海南医学院第二附属医院急诊科,海南 海口

出　　处：《临床医学进展》2023年第6期9257-9264,共8页Advances in Clinical Medicine

摘　　要：目的:探讨C-反应蛋白与白蛋白比值(CAR)、中性粒细胞与淋巴细胞比值(NLR)与脓毒症患者并发急性肾损伤(AKI)的相关性。方法:基于美国重症监护医学信息-III (MIMIC-III)数据库,提取脓毒症患者2310例作为训练集,并根据是否发生AKI将患者分为AKI组和非AKI组。收集患者的一般资料、基础疾病、实验室指标等,并根据入住重症监护病房(ICU)后24 h内血常规结果和血清C-反应蛋白、白蛋白水平计算CAR和NLR。应用单因素分析和多因素Logistic回归分析确定脓毒症患者并发AKI的独立预测因子,并以此构建预测脓毒症患者并发AKI风险的列线图模型。分别通过ROC曲线、校准曲线和决策曲线对列线图模型进行评价。另外选取在海南医学院第二附属医院收治的458例脓毒症患者作为验证集对列线图预测模型进行外部验证。结果:CAR和NLR均是脓毒症患者并发AKI的独立危险因素(均P < 0.05)。列线图预测模型具有较好的区分度、一致性和临床实用性。结论:CAR、NLR与脓毒症患者并发AKI风险密切相关。Objective: To investigate the relationship between C-reactive protein to albumin ratio (CAR), neu-trophil to lymphocyte ratio (NLR) and acute kidney injury (AKI) in patients with sepsis. Methods: Based on the American intensive care medical information-III (MIMIC-III) database, 2310 patients with sepsis were selected as the training set, and the patients were divided into AKI group and non-AKI group according to the occurrence of AKI. The general data, basic diseases and laboratory indexes of the patients were collected, and CAR and NLR were calculated according to the results of blood routine and the levels of serum C-reactive protein and albumin within 24 hours after admis-sion to the intensive care unit (ICU). Univariate analysis and multivariate Logistic regression analy-sis were used to determine the independent predictors of sepsis patients with AKI, and to build a nomogram model to predict the risk of sepsis patients with AKI. The nomogram model is evaluated by ROC curve, calibration curve and decision curve respectively. In addition, 458 patients with sep-sis treated in the second affiliated Hospital of Hainan Medical College were selected as the verifica-tion set to validate the nomogram prediction model. Results: Both CAR and NLR were independent risk factors for AKI in patients with sepsis (All P < 0.05). The nomogram prediction model has good differentiation, consistency and clinical practicability. Conclusion: CAR and NLR are closely related to the risk of AKI in patients with sepsis.

关 键 词：脓毒症 急性肾损伤 C-反应蛋白与白蛋白比值 中性粒细胞与淋巴细胞比值 列线图 

分 类 号：R69[医药卫生—泌尿科学]