临床症状和体征能否预测住院成人的肾功能减退？
Do clinical symptoms and signs predict reduced renal function among hospitalized adults?
作者信息
Kumar S, Joshi R, Joge V
机构信息
Department of Medicine, Jawahar Lal Nehru Medical College, DMIMS, Sawangi, Wardha, Maharashtra, India.
Department of Medicine, All India Institute of Medical Sciences Bhopal, Sewagram, Wardha, Maharashtra, India.
出版信息
Ann Med Health Sci Res. 2013 Oct;3(4):492-7. doi: 10.4103/2141-9248.122052.
BACKGROUND
Reduced renal function manifests as reduced glomerular filtration rate (GFR), which is estimated using the serum creatinine levels. This condition is frequently encountered among hospitalized adults. Renal dysfunction remains clinically asymptomatic, until late in the course of disease, and its symptoms and screening strategies are poorly defined.
AIM
We conducted this study to understand if the presence of renal dysfunction related clinical symptom and signs (either alone or in combination) can predict reduced GFR. Further, we aimed to determine if the combination of symptoms and signs are useful for prediction of different levels of reduced GFR.
SUBJECTS AND METHODS
We performed a cross-sectional clinical prediction study and included all consecutive patients admitted to the medical wards of the hospital. We used a renal dysfunction related clinical predictors as index tests and low estimated GFR ([eGFR] < 60 ml/min/1.73 m(2)) as a reference standard. We identified symptoms with a high likelihood ratio (LR) for prediction of low eGFR and constructed different risk score models. We plotted receiver operating curves for each score and used area under the curve (AUC) for comparison. The score with the highest AUC was considered as most discriminant. All statistical analysis was performed using the statistical software STATA (version 11.0, lake drive, Texas, USA).
RESULTS
A total of 341 patients participated in the study. None of the predictor variables had statistically significant LRs for eGFR less than 60 ml/min or eGFR less than 30 ml/min. Positive LRs were significant for prediction of eGFR < 15 ml/min for the presence of hypertension, vomiting pruritis, peripheral edema, hyperpigmentation, peripheral neuropathy and severe anemia. The best predictive model for eGFR less than 15 ml/min/1.73 m(2), included Age > 45 years, the presence of hypertension, vomiting, peripheral edema, hyperpigmentation, and severe anemia and had AUC of 0.82.
CONCLUSION
Clinical symptoms and signs are poorly predictive of reduced renal function, except for very low eGFR of less than 15 ml/min/1.73 m(2).
背景
肾功能减退表现为肾小球滤过率（GFR）降低，可通过血清肌酐水平进行估算。这种情况在住院成年人中经常出现。肾功能障碍在疾病晚期之前临床上通常无症状，其症状和筛查策略尚不明确。
目的
我们开展这项研究是为了了解肾功能障碍相关临床症状和体征（单独或联合出现）是否能够预测GFR降低。此外，我们旨在确定症状和体征的组合对于预测不同程度的GFR降低是否有用。
研究对象与方法
我们进行了一项横断面临床预测研究，纳入了医院内科病房所有连续收治的患者。我们将与肾功能障碍相关的临床预测指标作为指标检测，将低估算肾小球滤过率（[eGFR]<60 ml/min/1.73 m²）作为参考标准。我们确定了预测低eGFR的高似然比（LR）症状，并构建了不同的风险评分模型。我们绘制了每个评分的受试者工作曲线，并使用曲线下面积（AUC）进行比较。AUC最高的评分被认为是最具判别力的。所有统计分析均使用统计软件STATA（版本11.0，美国得克萨斯州莱克大道）进行。
结果
共有341名患者参与了该研究。对于eGFR低于60 ml/min或eGFR低于30 ml/min，没有一个预测变量具有统计学显著的似然比。对于预测eGFR<15 ml/min，高血压、呕吐、瘙痒、外周水肿、色素沉着、周围神经病变和严重贫血的存在具有显著的阳性似然比。对于eGFR低于15 ml/min/1.73 m²的最佳预测模型包括年龄>45岁、高血压、呕吐、外周水肿、色素沉着和严重贫血的存在，AUC为0.82。
结论
除了eGFR极低（低于15 ml/min/1.73 m²）的情况外，临床症状和体征对肾功能减退的预测能力较差。
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