脓毒症患者并发急性肾损伤的危险因素分析及Nomogram预测模型的构建OACSTPCD
Analysis of risk factors for acute kidney injury in patients with sepsis and construction of a Nomogram predictive model
目的 分析脓毒症患者并发急性肾损伤的危险因素,并构建列线图(Nomogram)预测模型.方法 选取2020年3月至2022年9月就诊的180例脓毒症患者为研究对象,根据患者是否并发急性肾损伤将其分为急性肾损伤组(n=75)和非急性肾损伤组(n=105).采用受试者工作特征(ROC)曲线分析连续性变量的预测价值;采用logistic回归分析影响脓毒症患者并发急性肾损伤的危险因素;采用内部数据验证No-mogram 模型临床效能.结果 两组患者在年龄等一般资料的比较中,差异无统计学意义(P＞0.05).与非急性肾损伤组相比,急性肾损伤组患者男性较多,肺部感染者较多,平均动脉压(MAP)、前降钙素水平较低,乳酸、白细胞计数、多器官功能衰竭(MODS)评分水平较高(P＜0.05).MAP、乳酸、前降钙素、白细胞计数、MODS 评分的 ROC 曲线下面积(AUC)为 0.823、0.921、0.663、0.948、0.946,最佳截断值为 89 mmHg、2.13 mmol/L、13.22 μg/L、15 × 109·L-1、6 分.性别(男)、肺部感染(是)、MAP(≤89 mmHg)、乳酸(＞2.13 mmol/L)、白细胞计数(＞15 × 109·L-1)、MODS评分(＞6分)均为影响脓毒症患者并发急性肾损伤的危险因素(P＜0.05).内部验证结果显示,Nomogram模型预测脓毒症患者并发急性肾损伤的风险C-index为0.763(95％CI:0.651-0.832);模型预测脓毒症患者并发急性肾损伤的风险阈值＞0.07,Nomogram模型提供临床净收益.结论 性别(男)、肺部感染(是)、MAP(≤89 mmHg)、乳酸(＞2.13 mmol/L)、白细胞计数(＞15 × 109·L-1)、MODS评分(＞6分)均为影响脓毒症患者并发急性肾损伤的危险因素,且基于以上变量构建的Nomo-gram模型可以对患者并发急性肾损伤进行较好的预测.
Objective To analyze the risk factors for acute kidney injury(AKI)in patients with sepsis and con-struct a Nomogram predictive model.Methods A total of 180 patients with sepsis from March 2020 to September 2022 were selected as the research subjects and divided into an AKI group(n=75)and a non-AKI group(n=105)based on the presence of AKI.The predictive value of continuous variables was analyzed by ROC experiments,and logistic regres-sion was used to analyze the risk factors for AKI in patients with sepsis.The clinical efficacy of the Nomogram model was validated using internal data.Results There were no statistically significant differences in general data between the two groups(P＞0.05).Compared with the non-AKI group,the AKI group had a higher proportion of males,more cases of pulmonary infection,lower mean arterial pressure(MAP),higher levels of lactate,white blood cell count,and multiple organ dysfunction syndrome(MODS)score(P＜0.05).The AUC values for MAP,lactate,procalcitonin,white blood cell count,and MODS score were 0.823,0.921,0.663,0.948,and 0.946,respectively.Male gender,pulmonary in-fection,MAP(≤89 mmHg),lactate(＞2.13 mmol/L),white blood cell count(＞15 × 109·L-1),and MODS score(＞6 points)were all risk factors for AKI in patients with sepsis(P＜0.05).The C-index for predicting the risk of AKI in patients with sepsis using the Nomogram model was 0.763(95％CI:0.651-0.832).Conclusion Male gender,pulmonary infection,low MAP,high lactate,elevated white blood cell count,and increased MODS score are risk factors for AKI in patients with sepsis.The nomogram model constructed based on these variables can effectively predict the oc-currence of AKI in patients with sepsis.
敖雪;邓超;侯宇;吴生赞
中南大学湘雅医学院附属海口医院重症医学科(海南海口 570208)
临床医学
脓毒症急性肾损伤危险因素Nomogram预测模型
sepsisacute kidney injuryrisk factorsNomogram prediction model
《广东医学》 2024 (006)
712-716 / 5
海南省自然科学基金面上项目(819MS139);海南省卫生计生行业科研项目(18A200087);海南省卫生健康行业科研项目(21A200058)
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