摘要
目的探讨影响脓毒症相关急性肾损伤(SAKI)患者启动连续性肾脏替代治疗(CRRT)后48内死亡的相关危险因素,及其对患者早期死亡的预测价值。方法对首都医科大学附属北京友谊医院重症医学科2016年1月至2021年12月收治的SAKI接受CRRT的258例患者的临床资料进行回顾性分析,根据患者是否在48 h内死亡分为存活组(203例)和死亡组(55例),以患者CRRT启动后48 h是否死亡为二分类结局变量,采用logistic回归评估早期死亡的影响因素,针对独立危险因素应用logistic回归构建联合预测因子,绘制受试者工作特征曲线(ROC),分析该联合预测因子对患者早期死亡的预测价值。结果258例接受CRRT的SAKI患者的早期病死率为21.3%。多因素二元logistic回归分析结果显示低肌酐水平[OR=1.50(每降低100μmol/L),95%CI:1.15~1.95],低氧合指数[OR=1.05(每降低10 mmHg),95%CI:1.02~1.09]及乳酸升高[OR=1.20(每升高1 mmol/L),95%CI:1.10~1.30]是接受CRRT治疗的SAKI患者早期死亡的独立危险因素。通过logistic回归生成新的联合预测因子,使用新的联合因子绘制ROC曲线,结果显示联合预测因子预测早期死亡的曲线下面积(AUC)为0.804。结论在接受CRRT的SAKI危重患者中低肌酐水平、低氧合指数及高乳酸水平显著影响早期病死率。3个指标构建的联合因子对早期死亡的预测有一定临床价值。
Objective To identify risk factors associated with 48-hour mortality following continuous renal replacement therapy(CRRT)initiation in patients with septic associated acute kidney injury(SAKI),and evaluate their predictive value for early mortality.Methods A retrospective cohort study of 258 SAKI patients who received CRRT in the Intensive Care Medicine Department of Beijing Friendship Hospital,Capital Medical University,between January 2016 and December 2021 was conducted.Patients were divided into survival group(203 cases)and non-survival group(55 cases)based on 48-hour mortality after CRRT initiation.Logistic regression was used to assess the risk factors for early mortality,and develop a composite predictor.Receiver operating characteristic(ROC)curve analysis was employed to assess the predictive performance of the combined prediction factor for early mortality.Results The 48-hour mortality rate was 21.3%.Multivariate logistic regression analysis revealed three independent risk factors for early death:lower creatinine levels[OR=1.50(per 100μmol/L decrease),95%CI:1.15-1.95],decreased oxygenation index[OR=1.05(per 10 mmHg decrease),95%CI:1.02-1.09],and elevated lactate levels[OR=1.20(per 1 mmol/L increase),95%CI:1.10-1.30].The composite predictor showed an AUC of 0.804.Conclusions The low levels of creatinine and oxygenation index,as well as high lactate levels in critically ill SAKI patients receiving CRRT,significantly influence the early mortality.The derived composite predictor demonstrates clinically meaningful performance for early mortality risk stratification.
作者
林瑾
赵宸龙
岳之琳
段美丽
Lin Jin;Zhao Chenlong;Yue Zhilin;Duan Meili(Department of Critical Care Medicine,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《中华重症医学电子杂志》
2025年第2期186-192,共7页
Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)
基金
首都卫生发展专项项目(首发2024-2-1179)
