中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (01): 12-16.doi: 10.3969/j.issn.1671-4091.2013.01.00

• 临床研究 • 上一篇    下一篇

住院患者急性肾损伤临床预后评分系统的建立及初步评估

陈颖颖,钱璟,马帅   

  1. 复旦大学附属华山医院肾脏科
  • 收稿日期:2012-07-23 修回日期:2012-09-07 出版日期:2013-01-12 发布日期:2013-01-04
  • 通讯作者: 陈颖颖 E-mail:dingfeng@fudan.edu.cn
  • 基金资助:

    本课题由国家自然科学基金(编号：81070609，30800526)、上海市科委课题(编号：09411961500，11441901401)和上海市浦江人才计划。

Establishment and preliminary evaluation of a prediction score system for the prognosis of acute kidney injury patients developed during hospitalization

  • Received:2012-07-23 Revised:2012-09-07 Online:2013-01-12 Published:2013-01-04

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摘要： 目的：明确住院患者急性肾损伤（AKI）的危险因素，并建立AKI预后评分系统。方法：入组上海市复旦大学附属华山医院2009年1月到2011年9月发生AKI的成人患者261例，构成试验组；2011年10月到2012年3月院内AKI的成人患者102例，构成验证组，分别随访90天，同时统计90天的死亡率。应用多因素Logistic回归分析确定AKI 90天死亡的独立危险因素，并根据其OR值赋予相应积分，形成评分系统，同时建立AKI 90天死亡率的预测曲线图。计算试验组和验证组各病例的总积分，比较不同得分组AKI死亡率。用ROC曲线和Hosmer-Lemeshow法评价该评分系统的效能。结果：（1）经多因素Logistic回归分析确定与AKI 90天预后相关的5个独立危险因素：并发症数目，使用血管活性物质（多巴胺），机械通气，尿素氮、前白蛋白。（2）试验组病例依据危险因素积分总和得出评分系统：总评分≤4分（低危组）AKI死亡率为16.8%；5～10分（中危组）死亡率为48.0%；11～16分（高危组）为76.0%；17～30分（极高危组）100%。ROC曲线下面积为0.801（p<0.001）。（3）经验证组证实，AKI总积分与其死亡率密切相关，该预后评分系统具有良好的预测能力(x2=4.149 ，p=0.657)。结论：该AKI预后评分系统可较为准确预测AKI 90天死亡率，为改善院内AKI患者的预后提供依据。

关键词: 急性肾损伤, 预后, 评分系统

Abstract: Abstract Objective: This study was designed to establish a clinical prediction score for the prognosis of acute kidney injury (AKI) in hospitalized patients. Methods: A total of 363 hospitalized patients were enrolled in Huashan hospital from January 2011 to March 2012. A prospective cohort study was performed on 261 patients of AKI in the development set, and 102 patients of AKI were selected for the validation set. Multivariate logistic regression analysis was applied to identify the risk factors of AKI and derivate a new prediction score based on the odds ratio . Thus the prediction curve for the mortality of AKI 90 days was established. The ROC curves and Hosmer-Lemeshow goodness-of-fit chi-squared test were used to assess the accuracy and efficacy of the scoring system. Results: (1)Five variables were identified as the independent risk factors of AKI: the total number of complications, vasopressor support (dopamine), mechanical ventilation, blood urea nitrogen(BUN) and serum prealbumin. (2) The total score was calculated for each patient. The incidence of AKI was 16.8%in the low-risk group(≤4 points), 48.0% in the moderate-risk groups(5-10 points), 76.0% in the high-risk group(11-16 points) and 100% in the very-high-risk group(17-30 points). The area under the ROC curve was 0.801(p<0.001). (3) Good discriminative power was found in the validation population, and the risk score was strongly correlated with AKI (χ2=4.149 , p=0.657). Conclusion: The scoring system could predict the mortality of hospital-acquired AKI patients accurately. Clinical application of this score may support decision making for protective kidney interventions and improve the prognosis of AKI patients in hospital.

Key words: Acute kidney injury, Prognosis, Prediction score