Drawz Paul E, Miller R Tyler, Sehgal Ashwini R
Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA.
Ren Fail. 2008;30(9):848-55. doi: 10.1080/08860220802356515.
Acute kidney injury is a major complication of hospitalization, occurring in 5-7 percent of hospitalized patients. The patient characteristics and prognostic variables that help predict acute kidney injury have not been studied in the general hospitalized population. The objectives of this study are to derive and validate a predictive score for hospital-acquired acute kidney injury (HAKI). We conducted a case-controlled study of HAKI involving 180 cases and 360 controls. A multivariate logistic regression model was developed in two-thirds of the subjects and validated in the other third. Upon admission, cases in the developmental sample were older (67 vs. 63 yrs, p = .008) and more likely to have diabetes (51% vs. 35%; p = .003), hypertension (77% vs. 60%, p = .001), heart failure (34% vs. 20%, p = .004), blood urea nitrogen >or=25 mg/dL (38% vs. 20%, p = <.001), creatinine >or=1.1 mg/dL (65% vs. 39%; p <.001), albumin <or=4 g/dL (85% vs. 71%; p = .033), and bicarbonate <24 mEq/L or >30 mEq/L (42% vs. 29%; p = .05) compared to controls. The final risk score included pulse, bicarbonate, creatinine, and specific medications (NSAIDs, ACE inhibitors, ARBs, and/or diuretics). The c-statistic for the risk score in the developmental sample was 0.69. In the validation sample, an increasing number of risk factors was associated with increased risk of HAKI (16% and 62% in the low and high-risk groups, respectively). In conclusion, a simple model based on readily available data stratifies patients according to their risk of developing HAKI and may guide clinical decision making and provide a basis for further research into HAKI.
急性肾损伤是住院治疗的主要并发症，在5%至7%的住院患者中发生。有助于预测急性肾损伤的患者特征和预后变量尚未在普通住院人群中进行研究。本研究的目的是推导并验证一种医院获得性急性肾损伤（HAKI）的预测评分。我们对HAKI进行了一项病例对照研究，涉及180例病例和360例对照。在三分之二的受试者中建立了多变量逻辑回归模型，并在另外三分之一的受试者中进行了验证。入院时，与对照组相比，开发样本中的病例年龄更大（67岁对63岁，p = 0.008），更有可能患有糖尿病（51%对35%；p = 0.003）、高血压（77%对60%，p = 0.001）、心力衰竭（34%对20%，p = 0.004）、血尿素氮≥25 mg/dL（38%对20%，p < 0.001）、肌酐≥1.1 mg/dL（65%对39%；p < 0.001）、白蛋白≤4 g/dL（85%对71%；p = 0.033）以及碳酸氢盐<24 mEq/L或>30 mEq/L（42%对29%；p = 0.05）。最终的风险评分包括脉搏、碳酸氢盐、肌酐和特定药物（非甾体抗炎药、血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂和/或利尿剂）。开发样本中风险评分的c统计量为0.69。在验证样本中，风险因素数量的增加与HAKI风险的增加相关（低风险组和高风险组分别为16%和62%）。总之，一个基于易于获得的数据的简单模型根据患者发生HAKI的风险对其进行分层，可能指导临床决策，并为进一步研究HAKI提供基础。
