急性胰腺炎合并急性肾损伤患者的预后评估
Prognostic evaluation of acute pancreatitis complicated with acute renal injury
张秋彬 1张楠 2林清婷 2徐军 2朱华栋 2姜辉2
作者信息
- 1. 570100 海口,海南医学院第二附属医院急诊科
- 2. 100730 北京,中国医学科学院北京协和医学院,北京协和医院急诊科、疑难重症及罕见病国家重点实验室
- 折叠
摘要
目的 评估急性胰腺炎(AP)合并急性肾损伤(AKI)患者的短期预后,并建立一个可预测AP合并AKI患者院内死亡风险的模型,探索其预后影响因素.方法 从重症监护医学信息数据库(MIMIC)Ⅳ 0.4中提取AP患者的临床数据.其后采用单因素及多因素logistic回归方法探索影响AP合并AKI患者预后的危险因素,在此基础上构建列线图.通过绘制受试者工作特征(ROC)曲线,判断其准确性.结果 共纳入1213例AP患者,根据AP患者是否合并AKI,将其分为AKI组(739例)和非AKI组(474例),两组患者院内病死率分别为9.9％(73/739)和2.1％(10/474).然后根据患者预后情况,将739例AP合并AKI患者分为存活组(666例)和死亡组(73例).经单因素及多因素logistic回归分析,结果提示年龄[比值比(OR)=1.033,95％置信区间(CI)(1.004,1.062),P=0.024],入院类型中相对于急诊入院,紧急入院[OR=2.203,95％CI(1.079,4.499),P=0.030]、择期入院[OR=0.134,95％CI(0.050,0.358),P＜0.001],高脂血症[OR=0.241,95％CI(0.124,0.468),P＜0.001],简化急性生理功能评分 Ⅱ(SAPS Ⅱ)[OR=1.038,95％CI(1.014,1.062),P=0.002],碳酸氢盐[OR=0.910,95％CI(0.853,0.970),P=0.004],休克[OR=2.273,95％CI(1.166,4.429),P=0.016]及腹腔间隔室综合征(ACS)[OR=3.873,95％CI(1.173,12.788),P=0.026]为AP合并AKI患者死亡的影响因素.根据影响因素构建预测模型,计算曲线下面积为0.885[95％CI(0.844,0.926),P＜0.001].结论 AP患者中,合并AKI者病情更严重,病死率明显升高,预后更差.基于年龄、入院类型、高脂血症、SAPSⅡ评分、碳酸氢盐、ACS、休克7项指标构建的列线图,对AP合并AKI患者具有较好的预测性能,有助于临床医生及时识别患者的死亡风险,从而采取更有效的治疗措施.
Abstract
Objective To explore the short-term prognosis of patients with acute pancreatitis(AP)complicated with acute kidney injury(AKI),and to establish a model that can predict the risk of in-hospital death in these patients so as to explore prognostic factors.Methods The clinical data of patients with AP were extracted from the medical information mart for intensive care(MIMIC)Ⅳ 0.4.Afterwards,single-factor and multi-factor logistic regression methods were used to explore the risk factors that affect the prognosis of patients with AP combined with AKI.A nomogram was constructed on this basis and a receiver operating characteristic(ROC)curve was drawn to judge its accuracy.Results Depending on whether they had concomitant AKI,a total of 1 213 patients with AP were included and separated into an AKI group(739 patients)and a non-AKI group(474 patients).The in-hospital mortality for the two groups was 9.9％(73/739)and 2.1％(10/474),respectively.Then,739 patients with AP and AKI were separated into survival(666 patients)and death(73 patients)groups based on their prognosis.The single-factor and multi-factor logistic regression analysis showed that age[odds ratio(OR)=1.033,95％confidence interval(CI)(1.004,1.062),P=0.024],urgent admission[OR=2.203,95％CI(1.079,4.499),P=0.030]and selective admission[OR=0.134,95％CI(0.050,0.358),P＜0.001]compared with emergent admission,hyperlipidemia[OR=0.241,95％CI(0.124,0.468),P＜0.001],simplified acute physiology score Ⅱ(SAPS Ⅱ)score[OR=1.038,95％CI(1.014,1.062),P=0.002],bicarbonate[OR=0.910,95％CI(0.853,0.970),P=0.004],shock[OR=2.273,95％CI(1.166,4.429),P=0.016],and abdominal compartment syndrome(ACS)[OR=3.873,95％CI(1.173,12.788),P=0.026]were influencing factors for in-hospital death in patients with AP complicated with AKI.A predictive model was constructed based on these influencing factors,and the area under the curve(AUC)was calculated to be 0.885[95％CI(0.844,0.926),P＜0.001].Conclusions Among AP patients,those with AKI are more seriously ill,with a significantly higher mortality rate and a worse prognosis.The nomogram constructed based on seven indicators of age,admission type,hyperlipidemia,SAPS Ⅱ score,bicarbonate,ACS,and shock has good predictive performance for patients with AP and AKI,which helps clinicians identify the risk of mortality in time and take more effective treatment measures.
关键词
急性胰腺炎/急性肾损伤/列线图/预后Key words
Acute pancreatitis/Acute renal injury/Nomogram/Prognosis引用本文复制引用
出版年
2023
NETL
NSTL
维普
万方数据