住院AKI患者病死率危險因素分析及預警模型建立和應用
發(fā)布時間：2018-08-29 17:10
【摘要】：目的 1.研究住院AKI患者90天及1年病死率相關的危險因素。 2.建立住院AKI患者90天及1年預后預警模型評價住院AKI患者的臨床預后。 方法 選取1996年1月到2013年4月中南大學湘雅二醫(yī)院各科室的成人住院AKI患者共1169例,采用2012年改善全球腎臟病預后組織(KDIGO)頒布的診斷標準,1996年1月至2007年12月的731例構成試驗組,2008年1月至2013年4月的438例構成驗證組。記錄入選患者的臨床基本資料,分別進行90天及1年的隨訪,或以患者死亡為終點事件,統(tǒng)計90天及1年病死率。將試驗組分為死亡組和存活組,比較兩組的參數(shù)差異,進一步應用多因素Logistic回歸分析分別確定AKI患者90天及1年死亡的獨立危險因素,根據(jù)各危險因素對應的OR值按照四舍五入的方法賦予其相應積分,計算各病例的總評分,計算各評分所對應的病死率。對各評分所對應的病死率行卡方趨勢性檢驗及作ROC曲線,秩和檢驗評價試驗組與驗證組死亡率的擬合度。分別建立90天及1年預后的預警模型,在驗證組中進行初步應用,利用CMHχ2檢驗(cochran mantel haeszel statistics)法驗證預警模型的預測性。 結(jié)果 1.試驗組與驗證組的90天病死率分別為13.8%、11.6%；1年病死率分別為14.8%、12.6%。 2.單因素分析顯示90天及1年預后中年齡、AKI類型、AKI病因、機械通氣、低血壓、休克、心衰、呼衰、胃腸道衰竭、中樞神經(jīng)系統(tǒng)衰竭、BUN峰值、K+峰值、ATN-ISS評分方面具有顯著統(tǒng)計學差異。多因素Logistic回歸分析,確定其90天死亡相關的危險因素,發(fā)現(xiàn)年齡、AKI類型、呼吸衰竭、中樞神經(jīng)系統(tǒng)衰竭、低血壓、ATNISI評分0.4為90天死亡相關的獨立危險因素。確定其1年死亡相關危險因素,發(fā)現(xiàn)年齡、AKI類型、呼吸衰竭、中樞神經(jīng)系統(tǒng)衰竭、低血壓為1年死亡相關的獨立危險因素。 3.使用卡方趨勢性檢驗對90天及1年預后評分系統(tǒng)進行趨勢檢驗,顯示病死率的變化有統(tǒng)計學意義(P0.001),預測90天及1年病死率的ROC曲線下面積分別為0.833(95%CI:0.788～0.879), P0.001;0.817(95%CI:0.771～0.864), P0.001 4.住院AKI患者90天及1年預后預警模型中試驗組與驗證組的病死率均無統(tǒng)計學差異(χ2=1.7958,P=0.1802;χ2=0.1006, P=0.7511),顯示這兩個預警模型對AKI的病死率均具有良好的預測能力。 結(jié)論 1.住院AKI患者的病死率為11.6%-14.8%。 2.年齡、AKI類型、呼吸衰竭、中樞神經(jīng)系統(tǒng)衰竭、低血壓、ATNISI評分0.4為住院AKI患者死亡相關的獨立危險因素。 3.本研究建立了兩個住院AKI患者死亡的預警模型,分數(shù)越高,病死率越高,預測價值均良好,有助于臨床醫(yī)師早期識別高�；颊�。
[Abstract]:Objective 1. To study the risk factors associated with 90 days and 1 year mortality in AKI patients. 2. A 90-day and 1-year prognostic early warning model was established to evaluate the clinical prognosis of hospitalized AKI patients. Methods from January 1996 to April 2013, 1169 adult AKI patients in Xiangya second Hospital of Central South University were selected. According to the diagnostic criteria issued by (KDIGO) for improving the prognosis of Nephropathy in 2012, 731 cases from January 1996 to December 2007 constituted a trial group, and 438 cases from January 2008 to April 2013 constituted a validation group. The basic clinical data were recorded, followed up for 90 days and 1 year, or the terminal events were the death of the patients, and the mortality of 90 days and 1 year were counted. The experimental group was divided into death group and survival group. The parameters of the two groups were compared, and the independent risk factors for 90 days and 1 year death of AKI patients were determined by multivariate Logistic regression analysis. According to the corresponding OR value of each risk factor according to the rounding method the corresponding integral was given to calculate the total score of each case and calculate the case fatality rate corresponding to each score. The mortality corresponding to each score was tested by chi-square trend test, ROC curve and rank sum test to evaluate the fitness of mortality between the test group and the validation group. The early warning models of 90 days and 1 year prognosis were established and applied in the validation group. CMH 蠂 2 test was used to verify the predictive value of the early warning model by (cochran mantel haeszel statistics) method. Result 1. The 90-day mortality of the test group and the validation group were 13.8and 11.60.The 1-year mortality was 14.8and 12.6, respectively. Univariate analysis showed significant difference in age type AKI etiology, mechanical ventilation, hypotension, shock, heart failure, respiratory failure, gastrointestinal failure, central nervous system failure, bun peak K peak and ATN-ISS score in 90 days and 1 year prognosis. Multivariate Logistic regression analysis showed that age type respiratory failure central nervous system failure and hypotension score 0. 4 were independent risk factors for 90 days death. The risk factors associated with one year death were determined. Age AKI type, respiratory failure, central nervous system failure and hypotension were found to be independent risk factors for 1 year death. The trend test of 90 days and 1 year prognostic scoring system by chi-square trend test showed that the change of mortality was statistically significant (P0. 001). The area under the ROC curve for predicting the mortality of 90 days and 1 year was 0.833 (95%CI:0.788~0.879), P0.001 + 0.817 (95%CI:0.771~0.864) and P0.001 4, respectively. There was no significant difference in mortality between the experimental group and the validation group in 90 days and 1 year prognostic early warning model of AKI patients in hospital (蠂 ~ (2 +) 1.7958 (P ~ (0.1802); 蠂 ~ (2 +) 0.1006, P ~ (0.7511), which indicated that the two early warning models had a good predictive ability to the mortality of AKI. Conclusion 1. The fatality rate of hospitalized patients with AKI was 11.6- 14.8. Age AKI type, respiratory failure, central nervous system failure, hypotension and ATNISI score 0.4 were independent risk factors for death in hospitalized AKI patients. In this study, two early warning models of death in AKI patients were established. The higher the score, the higher the mortality rate, and the better the predictive value was, which was helpful for clinicians to identify high-risk patients early.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692.5
本文編號：2211864
[Abstract]:Objective 1. To study the risk factors associated with 90 days and 1 year mortality in AKI patients. 2. A 90-day and 1-year prognostic early warning model was established to evaluate the clinical prognosis of hospitalized AKI patients. Methods from January 1996 to April 2013, 1169 adult AKI patients in Xiangya second Hospital of Central South University were selected. According to the diagnostic criteria issued by (KDIGO) for improving the prognosis of Nephropathy in 2012, 731 cases from January 1996 to December 2007 constituted a trial group, and 438 cases from January 2008 to April 2013 constituted a validation group. The basic clinical data were recorded, followed up for 90 days and 1 year, or the terminal events were the death of the patients, and the mortality of 90 days and 1 year were counted. The experimental group was divided into death group and survival group. The parameters of the two groups were compared, and the independent risk factors for 90 days and 1 year death of AKI patients were determined by multivariate Logistic regression analysis. According to the corresponding OR value of each risk factor according to the rounding method the corresponding integral was given to calculate the total score of each case and calculate the case fatality rate corresponding to each score. The mortality corresponding to each score was tested by chi-square trend test, ROC curve and rank sum test to evaluate the fitness of mortality between the test group and the validation group. The early warning models of 90 days and 1 year prognosis were established and applied in the validation group. CMH 蠂 2 test was used to verify the predictive value of the early warning model by (cochran mantel haeszel statistics) method. Result 1. The 90-day mortality of the test group and the validation group were 13.8and 11.60.The 1-year mortality was 14.8and 12.6, respectively. Univariate analysis showed significant difference in age type AKI etiology, mechanical ventilation, hypotension, shock, heart failure, respiratory failure, gastrointestinal failure, central nervous system failure, bun peak K peak and ATN-ISS score in 90 days and 1 year prognosis. Multivariate Logistic regression analysis showed that age type respiratory failure central nervous system failure and hypotension score 0. 4 were independent risk factors for 90 days death. The risk factors associated with one year death were determined. Age AKI type, respiratory failure, central nervous system failure and hypotension were found to be independent risk factors for 1 year death. The trend test of 90 days and 1 year prognostic scoring system by chi-square trend test showed that the change of mortality was statistically significant (P0. 001). The area under the ROC curve for predicting the mortality of 90 days and 1 year was 0.833 (95%CI:0.788~0.879), P0.001 + 0.817 (95%CI:0.771~0.864) and P0.001 4, respectively. There was no significant difference in mortality between the experimental group and the validation group in 90 days and 1 year prognostic early warning model of AKI patients in hospital (蠂 ~ (2 +) 1.7958 (P ~ (0.1802); 蠂 ~ (2 +) 0.1006, P ~ (0.7511), which indicated that the two early warning models had a good predictive ability to the mortality of AKI. Conclusion 1. The fatality rate of hospitalized patients with AKI was 11.6- 14.8. Age AKI type, respiratory failure, central nervous system failure, hypotension and ATNISI score 0.4 were independent risk factors for death in hospitalized AKI patients. In this study, two early warning models of death in AKI patients were established. The higher the score, the higher the mortality rate, and the better the predictive value was, which was helpful for clinicians to identify high-risk patients early.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692.5
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