摘要
目的探讨重症中暑后发生持续性急性肾损伤(persistent acute kidney injury,pAKI)的危险因素,构建预测模型。方法回顾性收集中国人民解放军南部战区总医院2013年1月至2023年12月收治的重症中暑患者177例,根据是否发生pAKI,将患者分为pAKI组(n=70)和对照组(n=107),比较两组患者临床特征差异,分析重症中暑患者发生pAKI的危险因素,根据相关危险因素,采用R4.2.1统计软件构建重症中暑患者发生pAKI预测模型,通过绘制校准曲线、决策曲线、临床影响曲线对模型进行验证。结果两组患者体温、白细胞、血小板、格拉斯哥昏迷评分(GCS)、横纹肌溶解、弥散性血管内凝血(DIC)、血肌酐、急性生理学与慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、心率、机械通气及使用血管活性药物等差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,APACHEⅡ评分(AUC=0.854,95%CI 0.809~0.921)和DIC(AUC=0.744,95%CI 0.752~0.855)是重症中暑患者发生pAKI的独立危险因素(P<0.05)。以APACHEⅡ评分和DIC作为变量构建pAKI列线图模型,经验证显示模型具有较好的可信度和预测价值。与对照组比较,pAKI组患者院内病死率和ICU住院时间显著增高(P<0.05)。结论APACHEⅡ评分和DIC是重症中暑合并pAKI的危险因素,本模型可识别重症中暑后出现pAKI的高危患者。
Objective To analyze the risk factors and construct predictive model for persistent acute kidney injury(pAKI)in heat stroke patients.Methods A retrospective collection of 177 heat stroke patients admitted to the General Hospital of the Southern Theater Command of Chinese People′s Liberation Army from January 2013 to December 2023 was conducted.Patients were divided into a pAKI group(n=70)and a control group(n=107)based on whether they had pAKI or not.The clinical characteristics of the two groups were compared,and the risk factors for pAKI in heat stroke patients were analyzed.Based on the relevant risk factors,a predictive model for the occurrence of pAKI in heat stroke patients was constructed by using R4.2.1 statistical software and validated by calibration curves,decision curves and clinical impact curves.Results There were significantly statistical differences in temperature,white blood cells,platelets,Glasgow coma scale(GCS),rhabdomyolysis,disseminated intravascular coagulation(DIC),creatinine,acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA),heart rate,mechanical ventilation,vasoactive drugs use(P<0.05).Multivariate Logistic regression analysis showed that APACHEⅡ(AUC=0.854,95%CI 0.809-0.921)and DIC(AUC=0.744,95%CI 0.752-0.855)were independent risk factors for pAKI in the patients with heat stroke(P<0.05).Based on APACHEⅡscore and DIC as variables,a pAKI nomogram model was successfully constructed,the validation results showed the model had good credibility and predictive value.Compared with the control group,the patients in the pAKI group had significantly higher in-hospital mortality and ICU hospitalization time(P<0.05).Conclusions APACHEⅡscore and DIC are risk factors for severe heat stroke combined with pAKI,and this model can identify the patients at high risk of pAKI after heat stroke.
作者
余阿红
殷冰凌
徐崇孝
肖盛华
董建光
林国东
Yu Ahong;Yin Bingling;Xu Chongxiao;Xiao Shenghua;Dong Jianguang;Lin Guodong(Intensive Care Medicine Department,the General Hospital of the Southern Theater Command of Chinese People′s Liberation Army,Guangzhou 510010,China)
出处
《中国急救医学》
CAS
CSCD
2024年第6期488-494,共7页
Chinese Journal of Critical Care Medicine
基金
国家自然科学基金(82202432)
广州市科技计划项目(2023A04J2059)。
