危重病评分及急性肾损伤分期在行连续性肾脏替代治疗的急性肾损伤患者预后中的应用价值

Predictive power of three Severity Scoring Systems and AKI classification on prognosis of acute kidney injury patients treated with continuous renal replacement therapy

目的探讨急性生理学与慢性健康状况评分(acute physiology and chronic healthevaluation,APACHE)Ⅱ、多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)评分、序贯性脏器衰竭评分(sequential organ failure assessment,SOFA)3种危重病评分系统和急性肾损伤(acutekidney injury,AKI)分期在行连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)的AKI患者中对预后的判断价值。方法以2006年1月至2010年12月上海交通大学附属第六人民医院重症监护病房(intensive care unit,ICU)及急诊重症监护病房(emergency intensive care unit,EICU)行CRRT治疗的AKI患者为研究对象,在入ICU、开始CRRT时分别进行APACHEⅡ、MODS、SOFA评分和AKI分期,并用受试者工作特征(receiver operating characteristic,ROC)曲线进行预后分析。结果共收集患者117例,117例患者存活45例,死亡72例,总病死率为61.5%。剔除肾脏替代治疗作为AKI分期标准,有25例AKI3期的患者在CRRT时分别纳入AKI1期和2期。APACHEⅡCRRT、MODSCRRT、SOFACRRT的ROC曲线下面积分别为0.901、0.851、0.885(P<0.001),而AKICRRT的ROC曲线下面积为0.617(P=0.034)。结论 APACHEⅡ、MODS及SOFA评分系统对行CRRT的AKI患者预后的判断价值较高,而AKI分期则意义不大。

Objective To investigate the effectiveness of APACHE II scores、MODS scores、SOFA scores and AKI classification for predicting prognosis in the acute kidney injury patients who treated with continuous renal replacement therapy（CRRT）. Methods We retrospectively analyzed the AKI patients in ICU of Shanghai Sixth People＇s Hospital affiliated to Shanghai Jiaotong University treated with CRRT in the period of Jan. 2006 to Dec. 2010. The APACHE II scores、MODS scores、SOFA scores were evaluated upon ICU admission and at the commencement of CRRT. Result A total of 117 AKI patients who treated with CRRT were enrolled. Seventy-two patients died. The overall mortality in hospital rate was 61.5%. Without renal replacement therapy as a criterion,25 patients would have been classified as AKI 3 classified as AKI 2 or AKI 1. Area under ROC （AUROC） curves for predicting death by APACHE IICRRT、MODSCRRT、SOFACRRT scores were 0.901、0.851、0.885 （P0.001）,higher than the AUROC of AKICRRT 0.617 （P=0.034）. Conclusion APACHE II、MODS、SOFA Scoring Systems are useful for evaluating the prognosis of AKI patients who treated with CRRT. AKI classification may have less predictive power.