Ohnuma Tetsu, Uchino Shigehiko, Toki Noriyoshi, Takeda Kenta, Namba Yoshitomo, Katayama Shinshu, Kawarazaki Hiroo, Yasuda Hideto, Izawa Junishi, Uji Makiko, Tokuhira Natsuko, Nagata Isao
Am J Nephrol. 2015;42(1):57-64. doi: 10.1159/000439118.
BACKGROUND/AIMS: Acute kidney injury (AKI) is associated with high mortality. Multiple AKI severity scores have been derived to predict patient outcome. We externally validated new AKI severity scores using the Japanese Society for Physicians and Trainees in Intensive Care (JSEPTIC) database.
New AKI severity scores published in the 21st century (Mehta, Stuivenberg Hospital Acute Renal Failure (SHARF) II, Program to Improve Care in Acute Renal Disease (PICARD), Vellore and Demirjian), Liano, Simplified Acute Physiology Score (SAPS) II and lactate were compared using the JSEPTIC database that collected retrospectively 343 patients with AKI who required continuous renal replacement therapy (CRRT) in 14 intensive care units. Accuracy of the severity scores was assessed by the area under the receiver-operator characteristic curve (AUROC, discrimination) and Hosmer-Lemeshow test (H-L test, calibration).
The median age was 69 years and 65.8% were male. The median SAPS II score was 53 and the hospital mortality was 58.6%. The AUROC curves revealed low discrimination ability of the new AKI severity scores (Mehta 0.65, SHARF II 0.64, PICARD 0.64, Vellore 0.64, Demirjian 0.69), similar to Liano 0.67, SAPS II 0.67 and lactate 0.64. The H-L test also demonstrated that all assessed scores except for Liano had significantly low calibration ability.
Using a multicenter database of AKI patients requiring CRRT, this study externally validated new AKI severity scores. While the Demirjian's score and Liano's score showed a better performance, further research will be required to confirm these findings.
背景/目的：急性肾损伤（AKI）与高死亡率相关。已经得出多种AKI严重程度评分来预测患者预后。我们使用日本重症监护医师和实习生协会（JSEPTIC）数据库对新的AKI严重程度评分进行了外部验证。
使用JSEPTIC数据库比较21世纪发布的新AKI严重程度评分（梅塔、斯图伊芬贝格医院急性肾衰竭（SHARF）II、改善急性肾疾病护理计划（PICARD）、韦洛尔和德米尔坚）、利亚诺、简化急性生理学评分（SAPS）II和乳酸水平。该数据库回顾性收集了14个重症监护病房中343例需要连续性肾脏替代治疗（CRRT）的AKI患者。通过受试者工作特征曲线下面积（AUROC，辨别力）和霍斯默-莱梅肖检验（H-L检验，校准）评估严重程度评分的准确性。
中位年龄为69岁，男性占65.8%。中位SAPS II评分为53分，医院死亡率为58.6%。AUROC曲线显示新的AKI严重程度评分辨别能力较低（梅塔0.65、SHARF II 0.64、PICARD 0.64、韦洛尔0.64、德米尔坚0.69），与利亚诺0.67、SAPS II 0.
