内科2026，Vol.21Issue(1)：23-31,9.DOI:10.16121/j.cnki.cn45-1347/r.2026.01.04
ICU终末期肾病患者的临床特征及短期与远期死亡的影响因素:基于MIMIC-Ⅳ数据库的分析
Clinical characteristics and influencing factors for short-and long-term mortality in ICU patients with end-stage renal disease:an analysis based on the MIMIC-Ⅳ
摘要
Abstract
Objective To analyze the clinical characteristics of patients with end-stage renal disease(ESRD)in the intensive care unit(ICU),and to explore the influencing factors for their short-and long-term mortality.Methods Based on the MIMIC-Ⅳ database,patients with discharge diagnoses including ESRD-related International Classification of Diseases codes were screened out,whose data on demographic characteristics,comorbidities and related scores,admission status and disease severity scores,laboratory indicators,therapeutic interventions,and outcome indicators were collected.Variables were initially screened using the Lasso-Cox regression model,and the multivariate Cox proportional hazards regression model was used to identify independent influencing factors for 30-day and 1-year mortality in ICU patients with ESRD,respectively.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive performance of the composite prediction models.Results A total of 1 185 ICU patients with ESRD were enrolled,with an age of 66.5(56.1,76.0)years,Simplified Acute Physiology Score Ⅱ of 44.0(34.0,52.0),Sequential Organ Failure Assessment(SOFA)score of 8.0(6.0,10.0),ICU length of stay of 2.9(1.8,5.3)days,and total hospital length of stay of 9.3(5.7,16.8)days,and their in-ICU,in-hospital,30-day,90-day,and 1-year mortality rates were 8.4%,13.9%,16.5%,24.3%,and 39.7%,respectively.Multivariate Cox proportional hazards regression analysis showed that older age,complicated with cerebrovascular disease,complicated with malignant tumor,elevated serum phosphorus level,elevated white blood cell count,and higher SOFA score were independent risk factors for 30-day mortality in ICU patients with ESRD(all HR＞1 and all P＜0.05),whereas the elevated serum creatinine level was an independent protective factor(HR＜1,P＜0.05);older age,admission via the emergency department,higher Charlson Comorbidity Index(CCI),elevated serum phosphorus level,elevated white blood cell count,elevated hemoglobin level,and higher SOFA score were independent risk factors for 1-year mortality in ICU patients with ESRD(all HR＞1 and all P＜0.05),whereas the elevated serum creatinine level and elevated serum albumin level were independent protective factors(all HR＜1 and all P＜0.05).The areas under the ROC curves for 30-day and 1-year mortality were 0.755 and 0.760,respectively,for the two composite prediction models constructed from the aforementioned independent influencing factors.Conclusion ICU patients with ESRD carry a high risk of long-term mortality.Age,serum phosphorus level,serum creatinine level,white blood cell count,and SOFA score are common independent influencing factors for both short-term and long-term mortality in this population;comorbid cerebrovascular disease and malignant tumor are independent risk factors for 30-day mortality,whereas admission via emergency department,CCI,hemoglobin level,and serum albumin level are independent influencing factors for 1-year mortality.The composite prediction models constructed from the aforementioned factors show favorable predictive performance.关键词
终末期肾病/重症监护室/短期死亡/远期死亡/影响因素/预后Key words
End-stage renal disease/Intensive care unit/Short-term mortality/Long-term mortality/Influencing factors/Prognosis分类
医药卫生引用本文复制引用
梁恋,许智坤,江意春,刘雪燕..ICU终末期肾病患者的临床特征及短期与远期死亡的影响因素:基于MIMIC-Ⅳ数据库的分析[J].内科,2026,21(1):23-31,9.基金项目
广东省深圳市科技计划项目(ZDSYS20200811142804014) （ZDSYS20200811142804014）
广东省深圳市医学研究专项资金资助项目(D2402002) （D2402002）
