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Received:July 17, 2024 Published Online:November 20, 2024
Received:July 17, 2024 Published Online:November 20, 2024
中文摘要: 目的 初步建立老年脓毒症合并急性肾损伤（AKI）患者住院期间死亡的预测模型，并进行验证。方法 回顾性纳入2019年1月至2023年12月于哈尔滨医科大学附属第一医院治疗的378例老年脓毒症合并AKI患者的临床资料。根据住院期间转归，将其分为死亡组122例（32.28%）和生存组256例（67.72%）。采用多因素logistic回归法筛选脓毒症AKI患者住院死亡的独立危险因素，并据此建立预测模型。采用受试者工作特征（ROC）曲线对模型进行评价。结果 多因素logistic回归结果显示，年龄＞70岁（OR=1.387, 95%CI: 1.083～1.776）、AKI Ⅲ期（OR=2.006, 95%CI: 1.388～2.899）、SOFA评分＞10分（OR=1.791, 95%CI: 1.266～2.536）、PCT＞3.67 ng/mL（OR=1.553, 95%CI: 1.166～2.068）、APTT＞40 s（OR=1.290, 95%CI: 1.040～1.602）是老年脓毒症合并AKI患者住院期间全因死亡的独立危险因素（P＜0.05）。建立脓毒症合并AKI患者住院死亡风险（C-index）的方程，即 C-index=-1.722＋0.327×（年龄）＋0.696×（AKI分期）＋0.583×（SOFA）＋0.440×（PCT）＋0.255×（APTT）。ROC曲线显示，C-index预测老年脓毒症合并AKI患者住院死亡的曲线下面积为0.876（95%CI：0.837~0.915），准确率为81.22%，敏感度为78.69%，特异度为82.42%。结论 基于年龄、SOFA评分、PCT、AKI分期、APTT建立的预测模型有助于早期识别老年脓毒症合并AKI患者住院期间死亡高风险人群，进而早期干预并调整治疗策略，有助于患者预后的改善。
Abstract:Objective To initially establish a prediction model for death during hospitalization in elderly patients with sepsis combined with acute kidney injury (AKI) and validate it. Methods Clinical data of 378 elderly patients with sepsis combined with AKI treated in The First Affiliated Hospital of Harbin Medical University from January 2019 to December 2023 were retrospectively included. Based on the outcome during hospitalization, they were divided into death group (122 cases, 32.28%) and survival group (256 cases, 67.72%). Multivariate logistic regression was used to screen the independent risk factors for hospitalized death in septic AKI patients, and a prediction model was established accordingly. The model was evaluated using receiver operating characteristic (ROC) curves. Results The results of multivariate logistic regression showed that age＞70 years (OR=1.387, 95%CI: 1.083-1.776), AKI stage Ⅲ (OR=2.006, 95%CI: 1.388-2.899), sequential organ failure assessment (SOFA) score＞10 (OR=1.791, 95%CI: 1.266-2.536), procalcitonin (PCT)＞3.67 ng/mL (OR=1.553, 95%CI: 1.166-2.068), and activated partial thromboplastin time (APTT)＞40 s (OR=1.290, 95%CI: 1.040-1.602) were independent risk factors for all-cause mortality during hospitalization in elderly patients with sepsis combined with AKI (P＜0.05). Based on the results of multivariate analysis, an equation for the risk of in-hospital death (C-index) in patients with sepsis combined with AKI was established, C-index=-1.722+0.327×(age)+0.696×(AKI stage)+0.583×(SOFA)+0.440×(PCT)+0.255×(APTT). The ROC curves showed that the C-index predicted in-hospital death in elderly patients with sepsis combined with AKI with an AUC of 0.876 (95%CI:0.837-0.915), an accuracy of 81.22%, a sensitivity of 78.69% and a specificity of 82.42%. Conclusion The prediction model based on age, SOFA score, PCT, AKI staging, and APTT can help to identify the high-risk group of elderly patients with sepsis combined with AKI at an early stage of death during hospitalization, and then intervene and adjust the treatment strategy at an early stage, which can help to improve the prognosis of patients.
keywords: Elderly Sepsis Acute kidney injury Activate partial thrombin time Sequential organ failure assessment
文章编号： 中图分类号：R631 文献标志码：A
基金项目:黑龙江省医学科技创新项目（H2020-L31）
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