Lu Jiaqi, Qi Zhili, Liu Jingyuan, Liu Pei, Li Tian, Duan Meili, Li Ang
Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China.
Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
Infect Drug Resist. 2022 Aug 24;15:4785-4798. doi: 10.2147/IDR.S376168. eCollection 2022.
This study aims to investigate the effect of serum chloride and sodium ions on AKI occurrence in ICU patients, and further constructs a prediction model containing these factors to explore the predictive value of these ions in AKI.
The clinical information of patients admitted to ICU of Beijing Friendship Hospital Affiliated to Capital Medical University was collected for retrospective analysis. Logistic regression analysis was used to analyzing the influencing factors. A nomogram for predicting AKI risk was constructed with R software and validated by repeated sampling. Afterwards, the effectiveness and accuracy of the model were tested and evaluated.
A total of 446 cases met the requirements of this study, of which 178 developed AKI during their stay in ICU, with an incidence rate of 39.9%. Hypernatremia, heart failure, sepsis, APACHE II score, and initial creatinine value and BE value at ICU admission before the diagnosis of AKI were identified as independent risk factors for developing AKI during ICU stay. These predictors were incorporated into the nomogram of AKI risk in critically ill patients, which was constructed by using R software. Receiver operating characteristic curve analysis was further used and showed that the area under the curve of the model was 0.7934 (95% CI 0.742-0.8447), indicating that the model had an ideal value. Finally, further evaluated its clinical effectiveness. The clinical effect curve and decision curve showed that most areas of the decision curve of this model were greater than 0, indicating that this model owned a certain clinical effectiveness.
The nomogram based on hypernatremia, heart failure, sepsis, APACHE II score, and initial creatinine and BE value in ICU can predict the individualized risk of AKI with satisfactory distinguishability and accuracy.
本研究旨在探讨血清氯离子和钠离子对ICU患者急性肾损伤（AKI）发生的影响，并进一步构建包含这些因素的预测模型，以探究这些离子在AKI中的预测价值。
收集首都医科大学附属北京友谊医院ICU收治患者的临床资料进行回顾性分析。采用Logistic回归分析影响因素。使用R软件构建预测AKI风险的列线图，并通过重复抽样进行验证。之后，对模型的有效性和准确性进行测试和评估。
共有446例患者符合本研究要求，其中178例在ICU住院期间发生AKI，发生率为39.9%。高钠血症、心力衰竭、脓毒症、急性生理与慢性健康状况评分系统（APACHE）II评分、AKI诊断前ICU入院时的初始肌酐值和碱剩余（BE）值被确定为ICU住院期间发生AKI的独立危险因素。将这些预测因素纳入危重症患者AKI风险列线图，该列线图由R软件构建。进一步采用受试者工作特征曲线分析，结果显示模型的曲线下面积为0.7934（95%可信区间0.742 - 0.8447），表明该模型具有理想价值。最后，进一步评估其临床有效性。临床效应曲线和决策曲线显示该模型决策曲线的大部分区域大于0，表明该模型具有一定的临床有效性。
基于ICU患者高钠血症、心力衰竭、脓毒症、APACHE II评分以及初始肌酐和BE值构建的列线图，能够以令人满意的区分度和准确性预测AKI的个体化风险。
