da Hora Passos Rogério, Ramos João Gabriel Rosa, Mendonça Evandro Jose Bulhoes, Miranda Eva Alves, Dutra Fábio Ricardo Dantas, Coelho Maria Fernanda R, Pedroza Andrea C, Correia Luis Claudio L, Batista Paulo Benigno Pena, Macedo Etienne, Dutra Margarida M D
Hospital Português, Salvador, Brazil.
Hospital São Rafael, Salvador, Brazil.
BMC Anesthesiol. 2017 Feb 7;17(1):21. doi: 10.1186/s12871-017-0312-8.
This study aimed to identify predictors of early (7-day) mortality in patients with septic acute kidney injury (AKI) who required continuous renal replacement therapy (CRRT).
Prospective cohort of 186 septic AKI patients undergoing CRRT at a tertiary hospital, from October 2005 to November 2010.
After multivariate adjustment, five variables were associated to early mortality: norepinephrine utilization, liver failure, medical condition, lactate level, and pre-dialysis creatinine level. These variables were combined in a score, which demonstrated good discrimination, with a C-statistic of 0.82 (95% CI = 0.76-0.88), and good calibration (χ = 4.3; p = 0.83). SAPS 3, APACHE II and SOFA scores demonstrated poor performance in this population.
The HEpatic failure, LactatE, NorepInephrine, medical Condition, and Creatinine (HELENICC) score outperformed tested generic models. Future studies should further validate this score in different cohorts.
本研究旨在确定需要持续肾脏替代治疗（CRRT）的脓毒症急性肾损伤（AKI）患者早期（7天）死亡率的预测因素。
对2005年10月至2010年11月在一家三级医院接受CRRT的186例脓毒症AKI患者进行前瞻性队列研究。
经过多变量调整后，有五个变量与早期死亡率相关：去甲肾上腺素的使用、肝功能衰竭、病情、乳酸水平和透析前肌酐水平。这些变量被整合为一个评分，该评分显示出良好的区分度，C统计量为0.82（95%置信区间=0.76-0.88），校准良好（χ=4.3；p=0.83）。序贯器官衰竭评估（SOFA）评分、简化急性生理学评分（SAPS）3和急性生理与慢性健康状况评分系统（APACHE）II在该人群中表现不佳。
肝功能衰竭、乳酸、去甲肾上腺素、病情和肌酐（HELENICC）评分优于所测试的通用模型。未来的研究应在不同队列中进一步验证该评分。
