| 摘要: |
| 目的 基于脓毒症急性肾损伤（AKI）恶性肿瘤患者的凝血及炎症指标构建连续性肾脏替代疗法（CRRT）预后的预测模型。方法 纳入我院2020年1月至2021年12月收治的79例CRRT治疗的脓毒症AKI恶性肿瘤患者为研究对象，根据患者CRRT治疗后28 d内的预后情况分为死亡组（n＝20）和存活组（n＝59）。对两组患者的基本资料及治疗前、治疗6 h、治疗12 h时的凝血功能和炎症指标进行比较，将差异有统计学意义的变量纳入logistic回归分析，以明确影响脓毒症AKI恶性肿瘤患者CRRT预后的危险因素。结果 与治疗前相比，CRRT治疗6 h、12 h时患者的血小板计数、D-二聚体、纤维蛋白原、白细胞计数、中性粒细胞比例、CRP、前降钙素原（PCT）、IL-6、IL-8均下降，而凝血酶原时间、活化部分凝血活酶时间、国际标准化比值均上升（P均＜0.05）。糖尿病、高血压病、肿瘤转移及CRRT治疗12 h时的血小板计数、D-二聚体、CRP、PCT是脓毒症AKI恶性肿瘤患者28 d内死亡的独立危险因素（P均＜0.05）。建立的logistic回归方程为联合预测因子＝D-二聚体＋2.134×血小板计数＋3.451×CRP＋4.160×PCT，若联合预测因子＞293.124则提示患者28 d内死亡的风险较高。结论 脓毒症AKI恶性肿瘤患者CRRT治疗12 h时的D-二聚体、血小板计数、CRP和PCT可用于预测28 d内预后。 |
| 关键词: 凝血指标 脓毒症 恶性肿瘤 急性肾损伤 连续性肾脏替代治疗 |
| DOI：10.16781/j.CN31-2187/R.20220496 |
| 投稿时间：2022-06-12修订日期：2023-02-23 |
| 基金项目:上海市自然科学基金(19ZR1456600). |
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| Construction of a prognostic prediction model for malignant tumor patients with sepsis-induced acute kidney injury treated with continuous renal replacement therapy |
| XU Ye-hao1,DAI Yuan-qiang1,SUN Hao-ran2,WAN Xiao-jian2* |
(1. Department of Anesthesiology, The First Affiliated Hospital of Naval Medical University(Second Military Medical University), Shanghai 200433, China;
2. Department of Critical Care Medicine, The First Affiliated Hospital of Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To construct a prognostic prediction model for malignant tumor patients with sepsis-induced acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT) based on coagulation and inflammatory indicators. Methods Seventy-nine malignant tumor patients with sepsis-induced AKI treated with CRRT in our hospital from Jan. 2020 to Dec. 2021 were enrolled. They were divided into death group (n＝20) and survival group (n＝59) based on their prognosis within 28 d after CRRT. The baseline data and levels of coagulation and inflammation indicators were compared between the 2 groups before, 6 h and 12 h after CRRT, and variables with significant differences were included in the logistic regression analysis to identify risk factors that affect the prognosis of malignant tumor patients with sepsis-induced AKI. Results Compared with pre-treatment, the levels of platelet, D-dimer, fibrinogen, white blood cell, neutrophil ratio, C reactive protein (CRP), procalcitonin (PCT), interleukin (IL)-6 and IL-8 were significantly decreased at 6 h and 12 h after CRRT, while the prothrombin time, activated partial thromboplastin time and international normalized ratio were significantly increased (all P＜0.05). Diabetes mellitus, hypertension, metastasis and levels of platelet, D-dimer, CRP and PCT at 12 h after CRRT were independent risk factors for the death of malignant tumor patients with sepsis-induced AKI within 28 d (all P＜0.05). Logistic regression indicated that the prognosis prediction formula could be expressed by Y-union＝D-dimer＋2.134×platelet＋ 3.451×CRP＋4.160×PCT, and the threshold value＞293.124 indicated a higher risk of death within 28 d. Conclusion Levels of D-dimer, platelet, CRP and PCT in malignant tumor patients with sepsis-induced AKI at 12 h after CRRT can be used to predict the prognosis within 28 d. |
| Key words: coagulation index sepsis malignant neoplasms acute kidney injury continuous renal replacement therapy |
