目的 探讨中重度肾功能不全患者接受注射用伏立康唑后发生急性肾损伤（AKI）的危险因素并建立预测AKI发生风险的模型。 方法 研究设计为回顾性研究。研究对象选自2020年1月1日至2022年12月31日在河南省焦作市人民医院住院并接受注射用伏立康唑治疗的中重度肾功能不全患者。通过医院信息系统，收集患者临床资料，包括基本信息、临床诊断、实验室检查指标、合并疾病和联合用药等。根据是否发生伏立康唑相关AKI将患者分为AKI组和无AKI组。采用多因素logistic回归法分析AKI危险因素，并依此建立预测模型。采用R 4。2。3软件绘制校准曲线，并用k折交叉验证法对模型进行内部验证。 结果 共有146例患者纳入研究，年龄（72。4±13。8）岁，男性84例、女性62例，发生伏立康唑相关AKI者61例（41。8%）。与无AKI组比较，AKI组用药前白细胞计数、中性粒细胞百分比、合并肾脏基础疾病者占比、合并心血管系统疾病者占比较高，注射用伏立康唑用药天数、合并血液系统疾病者占比、并用糖肽类药物者占比较低，差异均有统计学意义（P<0。05）。多因素logistic回归分析结果显示，白蛋白[X1，比值比（OR）=0。946，95%置信区间（CI）：0。915~0。977，P=0。001]、中性粒细胞百分比（X2，OR=1。013，95%CI：1。000~1。026，P=0。001）、合并肾脏基础疾病（X3，OR=2。230，95%CI：1。110~4。483，P=0。046）是中重度肾功能不全患者静脉应用伏立康唑发生AKI的独立影响因素。建立预测模型，得到联合预测因子Y=14。32X1+0。23X2-X3。当Youden指数最大值为0。382，对应其受试者工作特征曲线切点最佳值为-11。33。内部交叉验证结果显示，该模型准确率为0。70、Kappa系数（一致性）为0。37。 结论 中重度肾功能不全患者接受注射用伏立康唑后AKI的发生率为41。8%，白蛋白、中性粒细胞百分比、合并肾脏疾病是其独立影响因素。基于上述指标计算联合预测因子有助于预测AKI的发生风险，对临床有一定的参考价值。 Objective To explore the risk factors of acute kidney injury (AKI) in patients with moderate and severe renal insufficiency after receiving voriconazole for injection and to establish a model for predicting the occurrence risk。 Methods The study was designed as a retrospective study。 The subjects were selected from patients with moderate to severe renal insufficiency who were hospitalized in Jiaozuo People′s Hospital of Henan Province from January 1， 2020 to December 31， 2022 and received treatment with voriconazole for injection。 Through the hospital information system， clinical data of patients were collected， including basic information， clinical diagnosis， laboratory test indexes， comorbid diseases， and co-medication。 Patients were divided into AKI and non-AKI groups according to whether voriconazole-related AKI occurred。 AKI risk factors were analyzed using multiple logistic regression， and prediction models were established accordingly。 Calibration curves were plotted using R4。2。3 software， and the model was internally validated using the k-fold cross-validation method。 Results A total of 146 patients were enrolled in the study with an age of 72。4±13。8 years， including 84 males and 62 females 61 patients (41。8%) of which developed voriconazole-related AKI。 Compared with the non-AKI group， the white blood cell count， neutrophils percentage， proportion of patients with basic renal diseases， and proportion of patients with cardiovascular diseases were higher in the AKI group the days of voriconazole injection treatment， proportion of patients with hematological diseases， and proportion of patients receiving glycopeptide drugs were lower in the AKI group。 The results of multiple logistic regression showed that albumin [X1， odds ratio(OR)=0。946， 95% confidence interval(CI): 0。915-0。977， P=0。001]， neutrophil percentage (X2， OR=1。013， 95%CI: 1。000- 1。026， P=0。001)， and complicated with underlying renal diseases (X3， OR=2。230， 95%CI: 1。110-4。483， P= 0。046) were independent influencing factors of AKI caused by voriconazole for injection in patients with moderate and severe renal insufficiency。 The prediction model was established and the joint prediction factor Y=14。32X1+0。23X2-X3。 When the maximum value of Youden index was 0。382， the best tangent point of receiver operating characteristic curve was -11。33。 The internal cross-validation results showed that the accuracy of the model was 0。70 and the Kappa coefficient (consistency) was 0。37。 Conclusions The incidence of AKI in patients with moderate and severe renal insufficiency after receiving voriconazole for injection was 41。8%。 Albumin， neutrophil percentage and underlying renal diseases were the independent influencing factors。 The calculation of joint predictors based on the above indicators was helpful to predict the risk of AKI and had a certain reference value for clinic。
Risk factors and prediction models for acute kidney injury caused by voriconazole for injection in patients with moderate to severe renal insufficiency
Objective To explore the risk factors of acute kidney injury (AKI) in patients with moderate and severe renal insufficiency after receiving voriconazole for injection and to establish a model for predicting the occurrence risk. Methods The study was designed as a retrospective study. The subjects were selected from patients with moderate to severe renal insufficiency who were hospitalized in Jiaozuo People′s Hospital of Henan Province from January 1, 2020 to December 31, 2022 and received treatment with voriconazole for injection. Through the hospital information system, clinical data of patients were collected, including basic information, clinical diagnosis, laboratory test indexes, comorbid diseases, and co-medication. Patients were divided into AKI and non-AKI groups according to whether voriconazole-related AKI occurred. AKI risk factors were analyzed using multiple logistic regression, and prediction models were established accordingly. Calibration curves were plotted using R4.2.3 software, and the model was internally validated using the k-fold cross-validation method. Results A total of 146 patients were enrolled in the study with an age of 72.4±13.8 years, including 84 males and 62 females 61 patients (41.8%) of which developed voriconazole-related AKI. Compared with the non-AKI group, the white blood cell count, neutrophils percentage, proportion of patients with basic renal diseases, and proportion of patients with cardiovascular diseases were higher in the AKI group the days of voriconazole injection treatment, proportion of patients with hematological diseases, and proportion of patients receiving glycopeptide drugs were lower in the AKI group. The results of multiple logistic regression showed that albumin [X1, odds ratio(OR)=0.946, 95% confidence interval(CI): 0.915-0.977, P=0.001], neutrophil percentage (X2, OR=1.013, 95%CI: 1.000- 1.026, P=0.001), and complicated with underlying renal diseases (X3, OR=2.230, 95%CI: 1.110-4.483, P= 0.046) were independent influencing factors of AKI caused by voriconazole for injection in patients with moderate and severe renal insufficiency. The prediction model was established and the joint prediction factor Y=14.32X1+0.23X2-X3. When the maximum value of Youden index was 0.382, the best tangent point of receiver operating characteristic curve was -11.33. The internal cross-validation results showed that the accuracy of the model was 0.70 and the Kappa coefficient (consistency) was 0.37. Conclusions The incidence of AKI in patients with moderate and severe renal insufficiency after receiving voriconazole for injection was 41.8%. Albumin, neutrophil percentage and underlying renal diseases were the independent influencing factors. The calculation of joint predictors based on the above indicators was helpful to predict the risk of AKI and had a certain reference value for clinic.
万方数据
