Emergency Department & EICU, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi, China.
Emergency Department & EICU, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi, China.
Am J Med Sci. 2021 May;361(5):607-615. doi: 10.1016/j.amjms.2020.11.028. Epub 2020 Nov 26.
Acute kidney injury (AKI) is a severe and common complication in critically ill patients and is associated with increased morbidity and mortality. At present, there is not a tool to predict the prognosis of critically ill patients with AKI and treated with continuous renal replacement therapy (CRRT).
A retrospective cohort study was to construct a prediction model for the 28-day mortality of patients with AKI and treated with CRRT. From January 2009 to September 2016, A total of 846 cases were included in our study.
A total of five variables selected by multi-factor Cox regression analysis were used to constructed three predictive models and adopted bootstrapping for internal validation. Finally, we get five sets of models (three sets of construction models and two sets of internal verification models) with similar predictive value. The stepwise model, which including four variables (CCI score, Alb, Phosphate (24h) and SOFA score), was the simplest model, so we chose it as our final predictive model and constructed a nomogram based on it. The area under the ROC curve (AUC) of the stepwise model and the stepwise bootstrap model (BS stepwise) were respectively 0.78(0.75,0.82) and 0.78 (0.75,0.82). The AUC of the stepwise model and the BS stepwise in patients with sepsis were 0.77 (0.73,0.81) and 0.77 (0.73,0.81). The AUC of the stepwise model and the BS stepwise in patients without sepsis were 0.83 (0.78,0.89) and 0.83 (0.78,0.89).
We developed a four-marker-based prognostic tool that could effectively predict each individual's 28-day mortality for patients with AKI and treated with CRRT.
急性肾损伤（AKI）是危重病患者的一种严重且常见的并发症，与发病率和死亡率的增加有关。目前，尚无工具可预测接受连续肾脏替代治疗（CRRT）的 AKI 危重病患者的预后。
本回顾性队列研究旨在构建接受 CRRT 治疗的 AKI 患者 28 天死亡率预测模型。2009 年 1 月至 2016 年 9 月，共纳入 846 例患者。
多因素 Cox 回归分析共筛选出 5 个变量，用于构建 3 个预测模型，并采用 bootstrap 进行内部验证。最终得到 5 组具有相似预测价值的模型（3 组构建模型和 2 组内部验证模型）。逐步模型，包含 4 个变量（CCI 评分、Alb、磷酸盐（24h）和 SOFA 评分），是最简单的模型，因此我们选择它作为最终的预测模型，并基于此构建了一个列线图。逐步模型和逐步 bootstrap 模型（BS 逐步）的 ROC 曲线下面积（AUC）分别为 0.78（0.75，0.82）和 0.78（0.75，0.82）。脓毒症患者中逐步模型和 BS 逐步模型的 AUC 分别为 0.77（0.73，0.81）和 0.77（0.73，0.81）。非脓毒症患者中逐步模型和 BS 逐步模型的 AUC 分别为 0.83（0.78，0.89）和 0.83（0.78，0.89）。
我们开发了一种基于四个标志物的预后工具，可以有效地预测接受 CRRT 治疗的 AKI 患者的 28 天死亡率。
