Validation and evaluation of constructing a prognostic model for patients with sepsis and acute kidney injury combined with renal artery resistance index and β2 microglobulin and procalcitonin levels
-
摘要: 目的 联合肾动脉阻力指数、β2微球蛋白、降钙素原水平构建脓毒症合并急性肾损伤患者预后模型的验证评价。方法 选取2019年10月—2020年12月期间在我院内科及ICU进行治疗的107例脓毒症合并急性肾损伤患者作为研究对象。根据患者预后情况分为存活组(79例)和死亡组(28例)。比较两组患者肾动脉阻力指数(RRI)、β2微球蛋白(β2-MG)和降钙素原(PCT)各指标表达水平，同时采用Cox比例风险回归分析RRI、β2-MG和PCT各指标表达水平对脓毒症合并急性肾损伤患者预后情况的诊断价值，最后通过ROC曲线分析患者RI、β2-MG和PCT各指标表达水平对脓毒症合并急性肾损伤患者预后的预测能力。结果 死亡组患者RRI、β2-MG和PCT各指标表达水平明显高于存活组，两组之间差异有统计学意义(P＜0.05)；采用Cox比例风险回归分析结果显示，RRI、β2-MG和PCT各指标表达水平升高均为脓毒症合并急性肾损伤患者预后的独立危险因素；最后通过受试者工作特征曲线(ROC)分析结果显示，RRI、β2-MG和PCT单独预测脓毒症合并急性肾损伤患者预后的曲线下面积(AUC)分别为0.703、0.745、0.747，而三者联合检测预测脓毒症合并急性肾损伤患者预后的曲线下面积(AUC)为0.897，联合检测评估脓毒症合并急性肾损伤患者预后的曲线下面积(AUC)明显更优于单一指标的预测概率。RRI、血清β2-MG和PCT诊断脓毒症合并肾损伤患者预后的最佳截断值分别为1.37、4.57 mg/L和4.46 ng/mL。结论 RRI、β2-MG和PCT各指标表达水平与脓毒症合并急性肾损伤患者预后情况关系密切，联合检测RRI、β2-MG和PCT 3项指标可提高对脓毒症合并急性肾损伤患者的预后预测效能，同时可有效评估脓毒症合并急性肾损伤患者的预后。Abstract: Objective Combined with renal artery resistance index(RRI), β2 microglobulin(β2-MG), and procalcitonin(PCT) levels, the validation and evaluation of the prognosis model of patients with sepsis and acute kidney injury injury was constructed.Methods One hundred and seven patients with sepsis and acute kidney injury t who were treated in the Internal Medicine Department and ICU of our hospital from October 2019 to December 2020 were selected as the research objects. According to the prognosis of patients with sepsis and acute kidney injury, they were divided into survival group(n=79) cases and death group(n=28) cases. The RRI, β2-MG and PCT expression levels were compared between the two groups of patients. At the same time, multivariate Cox proportional hazards regression was used to analyze RRI, β2-MG and the diagnostic value of the expression levels of PCT indicators on the prognosis of patients with sepsis and acute kidney injury. Finally, the ROC curve was used to analyze the prognosistic value of expression levels of RRI, β2-MG and PCT in patients with sepsis andacute kidney injury.Results The expression levels of RRI, β2-MG and PCT in the death group were significantly higher than those in the survival group. The difference was statistically significant(P < 0.05). The results of multivariate Cox proportional hazards regression regression analysis showed that patients with sepsis and acute kidney injury Increased expression levels of RRI, β2-MG and PCT are all independent risk factors for the prognosis of patients with sepsis andacute kidney injury Finally, the results of receiver operating characteristic curve(ROC) analysis showed that sepsis. The area under the curve(AUC) of RRI, β2-MG and PCT in patients with acute kidney injury and sepsis individually predicting the prognosis of patients with sepsis and acute kidney injury are 0.703, 0.745, and 0.747, respectively, and the combined detection of the three predicts patients with sepsis and acute kidney injury The prognostic area under the curve(AUC) is 0.897. The area under the curve(AUC) of combined testing to assess the prognosis of patients with sepsis and acute kidney injury is significantly better than the predictive probability of a single index. The optimal cut-off values of RRI, serum β2-MG and PCT to diagnose the prognosis of patients with sepsis complicated with renal injury were 1.37, 4.57 mg/L and 4.46 ng/mL, respectively.Conclusion The expression levels of RRI, β2-MG and PCT in patients with sepsis andacute kidney injury are closely related to the prognosis of patients with sepsis and acute kidney injury. The three indicators of RRI, β2-MG and PCT in patients with sepsis and acute kidney injury are jointly detected. It can improve the performance of predicting the prognosis of patients with sepsis and acute kidney injury and can effectively assess the prognosis of patients with sepsis and acute kidney injury.
-
Key words:
- renal artery resistance index /
- β2 microglobulin /
- procalcitonin /
- sepsis /
- acute kidney injury
-
-
表 1 两组患者一般资料比较
例 项目 存活组（79例） 死亡组（28例） χ2/t P 年龄/岁 44.31±8.29 46.57±8.41 1.235 0.220 性别 1.108 0.292 男 36 16 女 43 12 居住地 0.331 0.565 农村 36 11 城市 43 17 AKI分期 0.106 0.949 AKI 1期 29 11 AKI 2期 28 9 AKI 3期 22 8 疾病类型 0.109 0.999 泌尿系感染 9 3 支气管哮喘合并感染 22 8 肺纤维化合并感染 7 2 社区获得性肺炎 36 13 其他感染 5 2 
下载: 导出CSV
表 2 两组脓毒症合并肾损伤患者RRI、β2-MG和PCT各指标表达水平对比
X±S 指标 存活组(79例) 死亡组(28例) t P RRI 1.01±0.21 1.31±0.44 3.463 0.001 β2-MG/(mg·L-1) 3.51±0.78 4.31±1.11 3.514 0.001 PCT/(ng·mL-1) 3.01±1.15 4.09±1.44 3.581 0.001
下载: 导出CSV
表 3 两组脓毒症合并急性肾损伤患者RRI、β2-MG和PCT各指标表达水平的多因素Cox回归分析
因素 β SE Waldχ2 P HR 95%CI 下限 上限 RRI -0.314 0.861 7.112 0.009 0.103 0.020 0.530 β2-MG -0.669 0.269 6.104 0.012 0.512 0.302 0.857 PCT -0.434 0.203 4.421 0.034 0.650 0.435 0.965
下载: 导出CSV
表 4 脓毒症合并肾损伤患者RRI、β2-MG和PCT各指标表达水平对脓毒症合并肾损伤患者预后的诊断价值
检测变量 AUC 标准差 P 最佳截断值 95%CI RRI 0.703 0.049 0.001 1.37 0.607~0.787 β2-MG 0.745 0.050 0.013 4.57 mg/L 0.652~0.824 PCT 0.747 0.050 0.001 4.46 ng/mL 0.653~0.826 联合预测 0.897 0.001 0.002 — 0.775~0.917
下载: 导出CSV
-
[1] Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016[J]. Int Care Med, 2017, 43(3): 304-377. doi: 10.1007/s00134-017-4683-6
[2] 安欣, 章志丹, 马晓春. 2016国际脓毒症和感染性休克管理指南与日本脓毒症诊疗指南之异同[J]. 中华危重病急救医学, 2017, 29(4): 289-293. doi: 10.3760/cma.j.issn.2095-4352.2017.04.001
[3] Brooks A, Woo KC, Wong SC. Post cardiac surgery sternal wound sepsis burden, risk factors and outcomes at Red Cross War Memorial Children's Hospital, Cape Town, South Africa: A five-year experience[J]. Trauma Quarterl, 2020, 15(2): 133-141.
[4] 奚希相, 李文放, 马金苗, 等. 尿NGAL联合MEDS评分评估脓毒症合并急性肾损伤患者病情及预后[J]. 第二军医大学学报, 2017, 38(2): 244-248. doi: 10.16781/j.0258-879x.2017.02.0244
[5] 邱佳男, 宋吉官, 陈龙, 等. KL-6和SP-D在脓毒症合并急性肺损伤患者中的表达及其与患者预后的关系[J]. 临床急诊杂志, 2021, 22(3): 188-192. http://zzlc.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=544d1971-537b-42f8-8d2b-ab2b92e54680
[6] 杨玉波, 李永华, 陈玺卿, 等. 脓毒症相关急性肾损伤患者血清NGAL、CysC水平变化及诊断价值研究[J]. 浙江医学, 2019, 41(10): 59-63. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYE201910017.htm
[7] 杨静, 何浩, 谭波, 等. 血清TLR4, MFG-E8及HMGB1对脓毒症患者并发急性肾损伤的诊断价值[J]. 山东医药, 2020, 60(1): 36-40. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY202001009.htm
[8] 邝泽建, 吴泽君, 韩飞, 等. 补体以及APTT对脓毒症合并急性肾损伤患者病情的预测作用分析[J]. 临床急诊杂志, 2021, 22(12): 791-795. http://zzlc.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=3124dbac-0464-4d21-995c-f740b785c7cf
[9] 中国医师协会急诊医师分会, 中国研究型医院学会休克与脓毒症专业委员会, 中国人民解放军总医院第一附属医院创伤研究中心, 等. 中国脓毒症/脓毒性休克急诊治疗指南(2018)[J]. 临床急诊杂志, 2018, 19(9): 567-588. http://zzlc.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=ce478df0-9502-409c-9353-75716b358639
[10] Gizem P, Anil UR, Elif C, et al. Sepsis and Septic Shock: Current Treatment Strategies and New Approaches[J]. Eur J Med, 2017, 49(1): 53.
[11] Dellinger RP, Schorr CA, Levy MM. A Users' Guide to the 2016 Surviving Sepsis Guidelines[J]. Crit Care Med, 2017, 45(3): 299-303.
[12] 杨玉波, 李永华, 陈玺卿, 等. 脓毒症相关急性肾损伤患者血清NGAL、CysC水平变化及诊断价值研究[J]. 浙江医学, 2019, 41(10): 59-63. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYE201910017.htm
[13] 姜少雄, 余海放, 曹钰, 等. 入院时急性肾损伤对重症肺炎并发脓毒症患者预后的预测价值[J]. 华西医学, 2019, 34(7): 790-795. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYX201907013.htm
[14] 吴丹. 血清胱抑素C联合尿中性粒细胞明胶酶相关脂质运载蛋白对脓毒症合并急性肾损伤的早期诊断价值[J]. 上海医学, 2020, 43(12): 45-50. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYX202012010.htm
[15] Yamakawa K, Murao S, Aihara M, et al. Recombinant Human Soluble Thrombomodulin in Sepsis-Induced Coagulopathy: An Updated Systematic Review and Meta-Analysis[J]. Thromb Haem, 2019.119(1): 56-65.
[16] 支海君, 张萌, 崔晓雅, 等. 肾脏超声和血清胱抑素对急性肾损伤的预测价值: 在心力衰竭与脓毒症患者中的不同之处[J]. 中华危重病急救医学, 2019, 31(10): 1258-1263.
[17] 陈骥, 伍海斌, 孙小聪, 等. 肾动脉阻力指数对脓毒症相关性急性肾损伤可逆性诊断的预测价值[J]. 广东医学, 2019, 40(13): 1971-1973. https://www.cnki.com.cn/Article/CJFDTOTAL-GAYX201913035.htm
[18] 付优, 何聪, 白银箱, 等. 肾阻力指数联合中心静脉压预测脓毒性休克患者发生急性肾损伤的价值[J]. 中华危重病急救医学, 2020, 32(4): 473-477.
[19] 朱宇芳, 饶群, 江华, 等. C3、C4和β2微球蛋白水平联合检测在脓毒症患者诊断和预后评估中的应用[J]. 检验医学与临床, 2017, 14(1): 7-9. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYL201701004.htm
[20] 李湘, 罗燕青, 曲雷. 血乳酸、C反应蛋白、β2微球蛋白在脓毒症患者病情和预后评估中的应用[J]. 宁夏医科大学学报, 2017, 39(10): 1182-1184. https://www.cnki.com.cn/Article/CJFDTOTAL-XNXY201710022.htm
[21] 黄丹. 可溶性髓系细胞触发受体-1、降钙素原及超敏C反应蛋白在脓毒症诊断中的价值[J]. 内科急危重症杂志, 2017, 23(1): 32-34, 69. https://www.cnki.com.cn/Article/CJFDTOTAL-NKJW201701010.htm
[22] 郭亚威, 王征, 朱丹丹, 等. 降钙素原联合SOFA评分对老年脓毒症患者预后的评估价值[J]. 现代生物医学进展, 2019, 19(3): 458-460, 510. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX201903014.htm
-
图(1)
表(4)
计量
- 文章访问数: 455
- PDF下载数: 120
- 施引文献: 0