中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (01): 17-20.doi: 10.3969/j.issn.1671-4091.2013.01.00

• 临床研究 • 上一篇    下一篇

AKICS模型预测我国老年患者心脏术后急性肾损伤的价值

胡鹏华1,陈源汉1,梁馨苓2   

  1. 1. 广东省人民医院肾内科&血液净化中心 广东省医学科学院
    2. 广东省人民医院，广东省医学科学院
  • 收稿日期:2012-05-15 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: 梁馨苓 xinlingliang@yahoo.com E-mail:xinlingliang@yahoo.com
  • 基金资助:

    广东省科技计划项目(2010B031600157)

The value of AKICS score for the prediction of acute kidney injury after cardiac surgery in Chinese elderly patients 

  • Received:2012-05-15 Revised:2012-09-07 Online:2013-01-12 Published:2013-01-04

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摘要： 【摘要】 目的 评估AKICS模型在我国老年心脏手术患者，预测术后急性肾损伤（AKI）的价值。方法 回顾性收集我院2007年1月至2009年12月行瓣膜或（和）冠脉搭桥手术的老年患者(年龄≥65岁)的临床资料。采用RIFLE标准诊断的AKI作为观察终点。分别在老年心脏手术患者和手术前7天内未造影的患者，用接受者工作特征(ROC)曲线下面积和Hosmer-Lemeshow goodness-of-fit test检验模型的判别性与拟合度。 结果 共收集227例老年心脏手术患者的资料，其中141例患者术前7天未造影。在227例老年心脏手术患者，AKI发生率为63.9%（n=145），AKICS模型预测术后AKI的ROC曲线下面积为0.702（95%CI 0.631-0.772），拟合度检验为0.704；在术前7天未造影的141例患者，94例（66.7%）发生AKI，ROC曲线下面积为0.764（95%CI 0.684 -0.844），拟合度检验为0.906。 结论 AKICS模型可预测我国老年患者心脏手术后AKI的发生，在手术前7天内未造影的老年心脏手术患者，其预测价值更高

关键词: AKICS模型, 心脏手术, 肾损伤, 急性, 老年

Abstract: 【Abstract】 Objective The purpose of present study was to validate externally AKICS score for acute kidney injury (AKI) after cardiac surgery in Chinese elderly patients. Method We conducted a retrospective research in patients undergoing coronary artery bypass grafting surgery and (or) valve replacement at our center between January 1, 2007 and December 31, 2009. The primary outcome was AKI according to RIFLE criteria. The baseline serum creatinine was defined as the latest serum creatinine before surgery. For evaluation of the performance of model, the discrimination and calibration of AKICS score were measured in elderly patients undergoing surgery and patients who did not expose contrast media less than 7 days prior to surgery. Results Among 227 patients included in present study, 141 patients did not expose contrast media less than 7 days before surgery. The incidences of AKI between total elderly patients and patients who did not expose contrast media less than 7 days before surgery were 63.9% (145/227) and 66.7% (94/141), respectively. In total elderly patients, the discrimination of score using the area under the receiver operating characteristic (ROC) curve was 0.702 (95%CI 0.631-0.772); the calibration using Hosmer- Lemeshow goodness- of-fit test was 0.704. And in patients who did not expose contrast media less than 7 days before surgery, the area under ROC was 0.764 (95%CI 0.684-0.844) ; the calibration was 0.906. Conclusion AKICS score offers good performance, accurately predicting AKI according to RIFLE criteria, in elderly patients undergoing cardiac surgery. And this score is more suitable to be used in elderly patients who did not expose contrast media 7 days before cardiac surgery.

Key words: AKICS score, Cardiac surgery, Acute kidney injury, Elderly