血清总胆固醇水平可以预测医院获得性急性肾损伤患者的预后

Serum total cholesterol as mortality predictor for hospital-acquired acute kidney injury

目的观察急性肾损伤(AKI)患者确诊时的血清总胆固醇(TC)水平,评价其对AKI患者90d预后的预测价值。方法采取前瞻性队列研究,入选医院获得性AKI的成年患者176例,根据诊断AKI时血清TC水平分入低TC组(<2.8mmol/L)和高TC组(≥2.8mmol/L),均随访90d,观察终点事件为死亡。结果 176例AKI患者的血清TC水平为(3.61±1.49)mmol/L,其中TC水平<2.8mmol/L低胆固醇症患者48例(27.3%)。低TC组的病死率为54.2%例(26/48),高TC组为32.8%(42/128),Kaplan-Meier生存分析显示,两组间生存曲线的差异有统计学意义(P=0.006)。Cox风险模型回归分析显示,低胆固醇血症是AKI患者90d死亡的独立危险因素之一。Logistic回归模型受试者工作特征曲线的曲线下面积为0.588(95%CI为0.489～0.687)。结论血清TC水平可以预测医院获得性AKI患者的90d死亡。

Objective To evaluate the value of serum total cholesterol for prediction of 90-day mortality acute kidney injury （AKI） patients. Methods In a prospective cohort study, 176 hospital-acquired AKI patients were enrolled into low cholesterol group （〈2.8 mmol/L） and high cholesterol group （≥2.8 mmol/L） when they were diagnosed as AKI. All patients were followed up for 90 days. Results The mean serum total cholesterol was （3.61 ± 1.49） mmol/L. There were 48 patients （27.3%） with hypocholesterolemia （〈2.8 mmol/L）. The case fatality rate in low cholesterol group and high cholesterol group were 54.2% （26/48） and 32.8% （42/128）, respectively. Kaplan-Meier survival analysis showed that there was significant difference in survival curve between the two groups （ P = 0. 006）. Cox risk regression model showed that hypocholesterolemia was one of the independent predictors for death in 90 days after AKI. Logistic regression model receptor oriented curve showed that area under curve （AUC） was 0. 588 （95 % CI ： 0. 489- 0. 687） for total cholesterol. Conclusion Serum total cholesterol can be taken as a 90-day mortality predictor in hospital-acquired acute kidney injury. （Shanghai Med J, 2013, 36： 218-222）