KDIGO和ICA标准诊断住ICU的肝硬化患者急性肾损伤效能研究

doi:10.3969/j.issn.1672-5069.2020.03.023

摘要/Abstract

摘要： 目的急性肾损伤(AKI)在肝硬化患者中普遍存在,会导致病死率明显升高。改善全球肾脏病预后(KDIGO)标准具有很高的预后预测能力,但是最近国际腹水俱乐部(ICA)提出了一项新的诊断AKI标准。本研究比较了这两种标准诊断AKI及其预测预后的效能。方法回顾性分析2010年～2015年收治的245例入住ICU的肝硬化患者,收集临床资料。采用Logistic回归分析住院死亡的独立危险因素。应用受试者工作特征曲线下面积(AUROC)和Hosmer-Lemeshow检验评估不同AKI标准对预后的预测能力和拟合优度。结果本组住院死亡156例(63.7%);根据KDIGO和ICA标准,AKI发生率分别为63.7%和58.4%;AKI和尿量是住院死亡的独立危险因素;KDIGO标准(OR=1.703)的OR值比ICA标准(OR=1.547)更高;KDIGO标准和ICA标准预测死亡的AUROC分别为0.762和0.708,差异显著(P=0.014)。结论 KDIGO标准比ICA标准预测入住ICU的肝硬化患者住院死亡的能力更强。

关键词: 肝硬化, 急性肾损伤, 重症监护室, 死亡, 因素分析 , ,

Abstract: Objective Acute kidney injury (AKI) is common in patients with cirrhosis and associated with elevated in-hospital mortality. The Kidney Disease: Improving Global Outcomes (KDIGO) classification is a valuable clinical tool because of good prognostic efficacy. However, the International Club of Ascites (ICA) proposed a new approach for the diagnosis of AKI in patients with cirrhosis recently. This study aims to compare the clinical implication of these two classification systems with regard to in-hospital mortality. Methods 245 cirrhotic patients consecutively admitted to intensive care unit (ICU) of our hospital from 2010 to 2015 were retrospectively analyzed, and the demographic and clinical materials were collected. The incidence of AKI was determined according to KDIGO and ICA classification. The primary end point was in-hospital mortality. Results The overall in-hospital mortality in this series was 63.7%, and the incidences of AKI during ICU stay were 63.7% and 58.4% according to the KDIGO and ICA classification, associated with increased in-hospital mortality of 78.8% and 78.3%, respectively; The AKI and urine output were the independent risk factors for in-hospital mortality, and the risk factor for AKI occurrence by KDIGO (OR=1.703) was greater than that of ICA (OR=1.547). The AUROC for in-hospital mortality by ICA and KDIGO were 0.708 and 0.762, respectively, with significant difference (P=0.014). Conclusion The KDIGO classification is an useful scoring system for risk stratification, and it might provides us a more accurate tool for the prediction of prognosis in patients with cirrhosis admitted to ICU.

Key words: Liver cirrhosis, Acute kidney injury, Intensive care unit, Death, Logistic analysis

张铭,蒲琳,熊号峰,向攀,刘景院. KDIGO和ICA标准诊断住ICU的肝硬化患者急性肾损伤效能研究[J]. 实用肝脏病杂志, 2020, 23(3): 392-396.

Zhang Ming, Pu Lin, Xiong Haofeng, et al.. Comparison of KDIGO and ICA criteria in diagnosing acute kidney injury in critically ill cirrhotic patients[J]. Journal of Practical Hepatology, 2020, 23(3): 392-396.

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