构建手术源性急性肾损伤患者的预后转归预测模型及其应用性研究
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摘要
目的:完善手术源性急性肾损伤(acute kidney injury,AKI)患者的各项临床评分及生物学标志物检测,构建该类患者的预后生存模型,并验证其应用性。方法:连续性纳入我院泌尿外科及急重症医学科于2014年10月~2017年2月接诊的手术源性AKI患者为研究队列,完善相关临床资料、危重度评分,并观察起病后28d内的预后转归。依据各项临床评分及预后情况,对其进行危重度评判,并判定对该类患者生存的影响。结果:本次研究最终纳入141例手术源性AKI患者;8例失访;26例患者于伤后28d内死亡。(1)Cox回归分析显示,SOFA量表、uKIM-1、umAlb、uNGAL为手术源性AKI患者发病后28d内死亡的独立影响因素,上述4项因素均为危险性因素;(2)SOFA≥7.25分、uKIM-1≥140.45pg/ml、uNGAL≥119.21ng/ml的手术源性AKI患者,其病情更加严重、发病后致死时间更短,其中SOFA及uNGAL的临界值指标具有更高的危重度评判效能。结论:及时完善手术源性AKI患者的SOFA量表及uKIM-1、umAlb、uNGAL检查对于评判其预后具有重要临床价值,且SOFA≥7.25分、uNGAL≥119.21ng/ml为衡量手术源性AKI患者预后转归的临界点。
Objective:To improve the clinical scores and biological markers detection in surgical origin of acute kidney injury(AKI)patients,to construct the prognostic model for these patients and verify its applicability.Method:From October 2014 to February 2017,surgically induced AKI patients for the study cohort were continuously enrolled in urology department and emergency and intensive care unit Jing Men Second People's Hospital.We improved the relevant clinical data,critically ill score and observed the prognosis after 28 days of outcome.According to the clinical score and prognosis,we assessed its risk and determined the impact on the survival of such patients.Result:The study eventually included 141 patients with surgical-grade AKI,eight were lost of follow-up,and 26 patients died within 28 days of injury.(1)The Cox regression analysis showed that the SOFA scale,uKIM-1,umAlb and uNGAL were the independent influencing factors of death in 28 days after the onset of pathogenic AKI.The above four factors were risk factors.(2)SOFA≥7.25 points,uKIM-1≥140.45 pg/ml,uNGAL≥119.21 ng/ml of patients with surgical origin of AKI showed more serious,faster disease progression after onset.The threshold of SOFA and uNGAL indicators have higher value in the judgment.Conclusion:The improvement of SOFA scale and uKIM-1,umAlb and uNGAL in patients with surgical origin of AKI were of great clinical value.Furthermore,SOFA≥7.25 points,uNGAL≥119.21 ng/ml were regarded as the critical point of patients' prognosis.
Objective:To improve the clinical scores and biological markers detection in surgical origin of acute kidney injury(AKI)patients,to construct the prognostic model for these patients and verify its applicability.Method:From October 2014 to February 2017,surgically induced AKI patients for the study cohort were continuously enrolled in urology department and emergency and intensive care unit Jing Men Second People's Hospital.We improved the relevant clinical data,critically ill score and observed the prognosis after 28 days of outcome.According to the clinical score and prognosis,we assessed its risk and determined the impact on the survival of such patients.Result:The study eventually included 141 patients with surgical-grade AKI,eight were lost of follow-up,and 26 patients died within 28 days of injury.(1)The Cox regression analysis showed that the SOFA scale,uKIM-1,umAlb and uNGAL were the independent influencing factors of death in 28 days after the onset of pathogenic AKI.The above four factors were risk factors.(2)SOFA≥7.25 points,uKIM-1≥140.45 pg/ml,uNGAL≥119.21 ng/ml of patients with surgical origin of AKI showed more serious,faster disease progression after onset.The threshold of SOFA and uNGAL indicators have higher value in the judgment.Conclusion:The improvement of SOFA scale and uKIM-1,umAlb and uNGAL in patients with surgical origin of AKI were of great clinical value.Furthermore,SOFA≥7.25 points,uNGAL≥119.21 ng/ml were regarded as the critical point of patients' prognosis.
引文
1急性肾损伤专家共识小组.急性肾损伤诊断与分类专家共识[J].中华肾脏病杂志,2006,22(11):661-663.
2 陆任华,方燕,高嘉,等.住院患者急性肾损伤的发病及预后相关危险因素分析[J].中华肾脏病杂志,2012,28(3):194-201.
3 姜物华,丁小强,方艺,等.心脏外科手术后急性肾损伤及其预后的五种评分模型在中国患者的验证研究[J].中华肾脏病杂志,2013,29(6):413-419.
4 Devarajan P.Neutrophil gelatinase-associated lipocalin(NGAL):a new marker of kidney disease[J].Scand J Clin Lab Invest Suppl,2008,241:89-94.
5 Bellomo R,Ronco C,Kellum J A,et al.Acute renal failure definition,outcome measures,animal model,fluid therapy and informationneeds:the Second Interactional Consensus Conference of the Acute Dialysis Quality Initiative(ADQI)Group[J].Crit Care,2004,8(4):204-212.
6 Mehto R L,Keilum J A,Shah S V,et a1.Acute Kidney Injury Network:report of an initiative to improve outcomes in acute kidney injury[J].Crit Care,2007,11(2):R31.
7 刘敏,董浩,彭泳涵,等.经皮肾镜钬激光碎石术后急性肾损伤高危因素分析[J].临床泌尿外科杂志,2016,31(6):543-546.
8 Ceriani R,Mazzoni M,Bortone F,et al.Application of sequential organ failure assessment score to cardiac surgical patients[J].Chest,2003,123(4):1229-1239.
9 史浩,陈楠,张文,等.简化MDRD公式预测慢性肾病患者肾小球滤过率的应用评价及校正[J].中国实用内科杂志,2006,26(9):665-669.
10 岳金凤,吴大玮,李琛,等.以急性肾损伤网络标准评估重症监护病房患者急性肾损伤的发病率、预后及死亡相关危险因素[J].中华医学杂志,2011,91(4):260-265.
11 Ferguson M A,Vaidya V S,Waikar S S,et al.Urinary liver-type fatty acid binding protein predicts adverse outcomes in acute kidney injury[J].Kidney Int,2010,77(8):708-714.
12 Thakar C V,Arrigain S,Worley S,et al.A clinical score to predict acute renal failure after cardiac surgery[J].J Am Soc Nephrol,2005,16(1):162-168.
13 Kheterpal S,Tremper K K,Heung M,et al.Development and validation of an acute kidney injury risk index for patients undergoing general surgery:results from a national data set[J].Anesthesiology,2009,110(3):505-515.
14 章瞡,杨佳伟,顾燕,等.嗜中性粒细胞明胶酶相关载脂蛋白早期诊断冲击波碎石所致急性肾损伤的研究[J].中华临床医师杂志,2014,8(21):3818-3822.
15 李深,俞国旭.老年患者髋部手术后发生急性肾损伤的相关因素分析[J].中国中西医结合急救杂志,2012,17(2):105-107.
16 Soni S S,Ronco C,Katz N,et al.Early diagnosis of acute kidney injury:the promise of novel biomarkers[J].Blood Purif,2009,28(3):165-174.
17 郦忆,朱铭力,钱家麒,等.尿中性粒细胞明胶酶相关载脂蛋白和肝型脂肪酸结合蛋白对肝移植术后急性肾损伤的早期诊断价值[J].中华肾脏病杂志,2010,26(2):818-823.
18 Devarajan P.Neutrophil gelatinase-associated lipocalin(NGAL):a new marker of kidney disease[J].Scand J Clin Lab Invest Suppl,2008,241:89-94.
19 贾洪艳,李家瑞.生物学标志物在脓毒症肾损伤中的诊断价值[J].中华急诊医学杂志,2015,24(2):151-154.
20 许光银,乔彩霞,王志玉.多项生物学标志物联合检测在重症患者合并急性肾损伤早期诊断中的价值[J].中华肾脏病杂志,2014,30(3):166-171.
2 陆任华,方燕,高嘉,等.住院患者急性肾损伤的发病及预后相关危险因素分析[J].中华肾脏病杂志,2012,28(3):194-201.
3 姜物华,丁小强,方艺,等.心脏外科手术后急性肾损伤及其预后的五种评分模型在中国患者的验证研究[J].中华肾脏病杂志,2013,29(6):413-419.
4 Devarajan P.Neutrophil gelatinase-associated lipocalin(NGAL):a new marker of kidney disease[J].Scand J Clin Lab Invest Suppl,2008,241:89-94.
5 Bellomo R,Ronco C,Kellum J A,et al.Acute renal failure definition,outcome measures,animal model,fluid therapy and informationneeds:the Second Interactional Consensus Conference of the Acute Dialysis Quality Initiative(ADQI)Group[J].Crit Care,2004,8(4):204-212.
6 Mehto R L,Keilum J A,Shah S V,et a1.Acute Kidney Injury Network:report of an initiative to improve outcomes in acute kidney injury[J].Crit Care,2007,11(2):R31.
7 刘敏,董浩,彭泳涵,等.经皮肾镜钬激光碎石术后急性肾损伤高危因素分析[J].临床泌尿外科杂志,2016,31(6):543-546.
8 Ceriani R,Mazzoni M,Bortone F,et al.Application of sequential organ failure assessment score to cardiac surgical patients[J].Chest,2003,123(4):1229-1239.
9 史浩,陈楠,张文,等.简化MDRD公式预测慢性肾病患者肾小球滤过率的应用评价及校正[J].中国实用内科杂志,2006,26(9):665-669.
10 岳金凤,吴大玮,李琛,等.以急性肾损伤网络标准评估重症监护病房患者急性肾损伤的发病率、预后及死亡相关危险因素[J].中华医学杂志,2011,91(4):260-265.
11 Ferguson M A,Vaidya V S,Waikar S S,et al.Urinary liver-type fatty acid binding protein predicts adverse outcomes in acute kidney injury[J].Kidney Int,2010,77(8):708-714.
12 Thakar C V,Arrigain S,Worley S,et al.A clinical score to predict acute renal failure after cardiac surgery[J].J Am Soc Nephrol,2005,16(1):162-168.
13 Kheterpal S,Tremper K K,Heung M,et al.Development and validation of an acute kidney injury risk index for patients undergoing general surgery:results from a national data set[J].Anesthesiology,2009,110(3):505-515.
14 章瞡,杨佳伟,顾燕,等.嗜中性粒细胞明胶酶相关载脂蛋白早期诊断冲击波碎石所致急性肾损伤的研究[J].中华临床医师杂志,2014,8(21):3818-3822.
15 李深,俞国旭.老年患者髋部手术后发生急性肾损伤的相关因素分析[J].中国中西医结合急救杂志,2012,17(2):105-107.
16 Soni S S,Ronco C,Katz N,et al.Early diagnosis of acute kidney injury:the promise of novel biomarkers[J].Blood Purif,2009,28(3):165-174.
17 郦忆,朱铭力,钱家麒,等.尿中性粒细胞明胶酶相关载脂蛋白和肝型脂肪酸结合蛋白对肝移植术后急性肾损伤的早期诊断价值[J].中华肾脏病杂志,2010,26(2):818-823.
18 Devarajan P.Neutrophil gelatinase-associated lipocalin(NGAL):a new marker of kidney disease[J].Scand J Clin Lab Invest Suppl,2008,241:89-94.
19 贾洪艳,李家瑞.生物学标志物在脓毒症肾损伤中的诊断价值[J].中华急诊医学杂志,2015,24(2):151-154.
20 许光银,乔彩霞,王志玉.多项生物学标志物联合检测在重症患者合并急性肾损伤早期诊断中的价值[J].中华肾脏病杂志,2014,30(3):166-171.