急性心力衰竭患者发生急性肾损伤预警模型的建立与验证

    Establishing and validating a risk prediction model for acute kidney injury in patients with acute heart failure

    • 摘要: 目的 通过分析急性心力衰竭(acute heart failure,AHF)患者发生急性肾损伤(acute kidney injury,AKI)的危险因素,建立一个临床使用方便的预警模型以尽早识别高危患者,减少AKI的发生。方法 选取苏州大学附属第一医院2016年1月至2017年12月收治的386例AHF患者为研究对象。将研究对象随机分为模型组(257例)和验证组(129例)。分析AHF患者发生AKI的危险因素,依据各危险因素的β值分别对其进行评分,建立预警模型,分别采用受试者工作特征(receiver operator characteristic,ROC)曲线下面积和Hosmer-Lemeshow拟合优度检验评估模型的分辨力及校准度。结果 AHF患者中AKI的发生率为38.9%;Logistic回归分析显示,估算肾小球滤过率(estimated glomerular filtration rate,eGFR)<60 mL·min-1·(1.73 m2-1、年龄≥72岁、舒张压≤78 mmHg (1 mmHg=0.133 kPa)、空腹血糖(fasting plasma glucose,FPG)≥6.0 mmol/L和尿酸(uric acid,UA)≥430 μmol/L是AHF患者发生AKI的独立危险因素。根据β值对上述危险因素进行评分,建立预警模型。模型组和验证组的AUC分别为0.773和0.758,Hosmer-Lemeshow拟合优度检验P值分别为0.806和0.785,提示该模型的区分能力和校准度均较好。结论 本研究基于eGFR、年龄、舒张压、空腹血糖和尿酸建立的预警模型具有较高的分辨能力及校准度,临床使用方便。

       

      Abstract: Objective To explore the risk factors of acute kidney injury(AKI)in patients with acute heart failure(AHF)and establish a risk prediction model of facilitating an early identification of high risks for lowering the incidence of AKI.Methods From January 2016 to December 2017,a total of 386 AHF in patients at First Affiliated Hospital of Soochow University were selected as the study subjects.They were randomized into two groups of model(n=257)and verification(n=129).The risk factors of AKI were examined in AHF patients according to β scores of various factors.Through a risk prediction model,the area under curve(AUC)of receiver operating characteristic(ROC)and Hosmer-Lemeshow goodness-of-fit test were employed for evaluating resolutions and calibrations.Results The incidence of AKI was 38.9% in AHF patients.Logistic regression analysis revealed that estimated glomerular filtration rate(eGFR)<60 ml·min-1·(1.73 m2)-1 age ≥72 years,diastolic blood pressure(DBP)≤78 mmHg,fasting plasma glucose(FPG)≥6.0 mmol/L and uric acid(UA)≥430 μmol/L were independent risk factors for AKI in AHF patients.The above risk factors were β-scored on the basis of risk prediction model.The AUC of model and verification groups were 0.773 and 0.758 respectively,and the Hosmer-Lemeshow goodness-of-fit test P values were 0.806 and 0.785 respectively,indicating that the model had decent resolution and calibration.Conclusion The above risk prediction model based upon eGFR,age,DBP,FPG and UA has decent resolution and calibration.It should be further popularized in clinical practices.

       

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