解放军医学杂志2025，Vol.50Issue(8)：935-942,8.DOI:10.11855/j.issn.0577-7402.1629.2025.0303
脓毒症相关急性肾损伤患者28 d死亡风险预测模型的构建与验证
Construction and validation of a risk prediction model for 28-day mortality in patients with sepsis-associated acute kidney injury
摘要
Abstract
Objective To explore the risk factors for 28-day mortality of sepsis-associated acute kidney injury(SA-AKI)patients and to develop a nomogram risk prediction model.Methods A retrospective cohort study was conducted,involving 184 patients with SA-AKI admitted to the intensive care unit(ICU)of the 940th Hospital of Joint Logistic Support Force of PLA between January 2017 and December 2022.Patients were categorized into survival(n=135)and non-survival(n=49)groups based on 28-day mortality.Clinical data were collected,and statistically significant risk factors were preliminarily screened.Multivariate stepwise logistic regression analysis was performed to identify independent risk factors for 28-day mortality of SA-AKI patients.A nomogram predictive model was constructed using these factors,and internally validated with the Bootstrap method.The receiver operating characteristic curve(ROC curve)was drawn,and the area under the ROC curve(AUC)was calculated to verify the predictive value and accuracy of the model.Results The 28-day mortality rate among 184 SA-AKI patients was 26.6％(49/184).Multivariate stepwise logistic regression analysis identified multiple organ dysfunction syndrome(MODS)(OR=16.393,95％CI 4.317-62.254,P＜0.001),high acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score(OR=1.097,95％CI 1.036-1.161,P=0.002),low oxygenation index(OR=0.992,95％CI 0.986-0.998,P=0.015),low neutrophil count(OR=0.912,95％CI 0.860-0.968,P=0.002)and low fibrinogen concentration(OR=0.733,95％CI 0.549-0.978,P=0.034)as independent risk factors.The prediction model equation was P=1/1+e-logit(P),logit(P)=-1.626+2.797×MODS+0.092×AP ACHE Ⅱ+(-0.311)×fibrinogen+(-0.092)×neutrophil count+(-0.008)×oxygenation index.Internal validation with 1000 Bootstrap resamples showed high consistency between predicted and actual values.ROC analysis showed an AUC of 0.911(95％CI 0.868-0.955,P＜0.05)for the model,with 93.9％sensitivity and 78.5％specificity at a cut-off of 0.194.The Hosmer-Lemeshow test confirmed good calibration(P=0.62),and decision-making curve analysis demonstrated clinical utility within the high-risk threshold range(0.1-0.9).Conclusions MODS,high APACHE Ⅱ score,low oxygenation index,low neutrophil count,and low fibrinogen concentration are independent risk factors for 28-day mortality in SA-AKI patients.The developed nomogram risk prediction model may provide important guidance for predicting 28-day mortality in SA-AKI patients.关键词
脓毒症相关急性肾损伤/列线图/预测模型/logistic逐步回归Key words
sepsis-associated acute kidney injury/nomogram/prediction model/stepwise logistic regression分类
医药卫生引用本文复制引用
张江明,刘冬梅,王泽钤,徐存莲,邓排,伍杨,齐敏君,马璐妹,姚伟晴,刘东..脓毒症相关急性肾损伤患者28 d死亡风险预测模型的构建与验证[J].解放军医学杂志,2025,50(8):935-942,8.基金项目
甘肃省自然科学基金(21JR11RA005) （21JR11RA005）
兰州市科技计划项目(2023-ZD-180) This work was supported by the Natural Science Foundation of Gansu Province(21JR11RA005),and the Science and Technology Program of Lanzhou City(2023-ZD-180) （2023-ZD-180）
