摘要
目的:初步建立可预测肝硬化患者并发急性肾损伤(AKI)的模型并评价其性能。方法:回顾性纳入278例住院治疗的肝硬化患者,分为并发AKI组72例和无AKI组206例。采用单因素及多因素logistic回归分析肝硬化患者发生AKI的独立危险因素,并建立预测模型。采用受试者工作特征(ROC)曲线对预测模型的区分度进行评价。结果:与无AKI组比较,AKI组年龄>70岁、糖尿病、肝性脑病、上消化道出血、Child-Pugh C级比例、终末期肝病模型(MELD)评分、白蛋白-胆红素(ALBI)评分、乳酸、降钙素原(PCT)、中心静脉压(CVP)水平更高,血小板、白蛋白水平更低(P均<0.05)。多因素logistic回归分析显示,年龄、MELD评分、肝性脑病、PCT、CVP是肝硬化患者发生AKI的独立危险因素(OR分别为1.368、1.749、1.645、1.442、1.553)。肝硬化患者发生AKI的风险指数C-_(index)=-1.627+0.313×(年龄)+0.559×(MELD评分)+0.498×(肝性脑病)+0.366×(PCT)+0.440×(CVP)。ROC曲线显示,C-_(index)预测肝硬化患者住院期间发生AKI的曲线下面积(AUC)为0.896(95%CI:0.855~0.936),准确率为85.25%,灵敏度为81.94%,特异性为86.41%。结论:年龄、MELD评分、肝性脑病、PCT、CVP为肝硬化并发AKI的独立危险因素,据此建立的模型可用于预测AKI发生风险。
Objective:To establish a model that can predict the complication of acute kidney injury(AKI)in patients with liver cirrhosis and evaluate its performance.Methods:A total of 278 patients with liver cirrhosis were retrospectively included,and were divided into an AKI group[72 cases(25.90%)]and a non-AKI group[206 cases(74.10%)]according to whether they suffered from AKI during hospitalization.Independent risk factors for the occurrence of AKI during hospitalization in cirrhotic patients were analyzed using unifactorial and multifactorial logistic regression,and a prediction model was established.The discrimination of the prediction model was evaluated using ROC curves,and the results were expressed as AUC,accuracy,sensitivity and specificity.Results:Compared with the non-AKI group,the number of patients with age>70 years,diabetes and hepatic encephalopathy,proportion of upper gastrointestinal bleeding and Child-Pugh class C,MELD score,ALBI score,lactate,procalcitonin(PCT),and central venous pressure(CVP)significantly increased,and platelets and albumin significantly decreased in the AKI group(P<0.05).Multifactorial logistic regression analysis showed that age(OR=1.368),MELD score(OR=1.749),hepatic encephalopathy(OR=1.645),PCT(OR=1.442),and CVP(OR=1.553)were the independent risk factors for the occurrence of AKI during hospitalization in cirrhotic patients.The risk index C-_(index)=-1.627+0.313×(age)+0.559×(MELD score)+0.498×(hepatic encephalopathy)+0.366×(PCT)+0.440×(CVP)for the occurrence of AKI during hospitalization in cirrhotic patients.The ROC curve showed that the C-_(index) predicted AKI during hospitalization in cirrhotic patients with an AUC of 0.896(95%CI:0.855-0.936)with an accuracy of 85.25%,sensitivity of 81.94%and specificity of 86.41%.Conclusion:Age,MELD score,hepatic encephalopathy,PCT,and CVP are independent risk factors for AKI complication in liver cirrhosis,and the model established accordingly can predict the risk of AKI occurrence,and then assist in the development of clinical treatment strategies.
作者
马娜娜
朱明浩
MA Na-na;ZHU Ming-hao(Department of Critical Care Medicine,The First Affiliated Hospital of Harbin Medical University,Harbin Heilongjiang 150000,China)
出处
《内科急危重症杂志》
2025年第4期325-328,共4页
Journal of Critical Care In Internal Medicine
基金
黑龙江省卫生健康委科研课题(2020-106)。
