Khoundabi Batoul, Kazemnejad Anoshirvan, Mansourian Marjan, Hashemian Seyed Mohammadreza, Kazempoor Dizaji Mehdi
Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran.
Department of Epidemiology and Biostatistics, School of Public health , Isfahan University of Medical Sciences, Isfahan, IR Iran.
Trauma Mon. 2016 Mar 28;21(4):e23749. doi: 10.5812/traumamon.23749. eCollection 2016 Sep.
Admission to the ICU (intensive care unit) is frequently complicated by early AKI (acute kidney injury). The development of AKI following cardiac surgery is particularly associated with increased mortality and morbidity. According to AKIN (acute kidney injury network) criteria, UO (urinary output) is a predictor for AKI.
The goal of this study was to determine the effects of some AKI risk factors on AKI and also to investigate changes in UO as a predictor of AKI using joint modeling.
In a retrospective study, 300 cardiac-operated patients, who had been admitted over a period of three years, were selected according to the consecutive sample selection method, using the ICU at Masih Daneshvari Hospital in Iran as a referral center. The random mixed effect model and the survival model were used to investigate UO changes and estimate the effect of UO and other risk factors on the hazard rate of AKI in a joint analysis.
AKI occurred in 38.0% of patients. A significant decrease of UO occurred more often in female and infected patients, as well as those with a low DBP (diastolic blood pressure). The survival model showed that the risk of AKI in females, older patients and patients with low DBP, lower UO and with infection was higher (P = 0.001). Using joint modeling, the association parameter between the risk of AKI and UO was estimated (-0.3, P = 0.002).
Where there is a relationship between two longitudinal and survival responses, joint modeling can estimate it.
入住重症监护病房（ICU）常常并发早期急性肾损伤（AKI）。心脏手术后发生的AKI尤其与死亡率和发病率增加相关。根据急性肾损伤网络（AKIN）标准，尿量（UO）是AKI的一个预测指标。
本研究的目的是确定一些AKI危险因素对AKI的影响，并使用联合模型研究作为AKI预测指标的UO的变化。
在一项回顾性研究中，根据连续抽样选择方法，选取了伊朗马西·达内什瓦里医院ICU作为转诊中心，在三年期间收治的300例心脏手术患者。在联合分析中，使用随机混合效应模型和生存模型来研究UO变化，并估计UO和其他危险因素对AKI风险率的影响。
38.0%的患者发生了AKI。女性、感染患者以及舒张压（DBP）低的患者中，UO显著下降更为常见。生存模型显示，女性、老年患者以及DBP低、UO低且有感染的患者发生AKI的风险更高（P = 0.001）。使用联合模型，估计了AKI风险与UO之间的关联参数（-0.3，P = 0.002）。
当两个纵向反应和生存反应之间存在关系时，联合模型可以对其进行估计。
