KDIGO标准APACHEII与SOFA评分对脓毒症急性肾损伤患者的预后评估

Prognostic investigation of KDIGO criteria, APACHE II and SOFA scoring system in acute kidneyinjurycausedbysepsis

目的探讨急性肾损伤国际指南（KDIGO）制定的急性肾损伤（AKI）诊断分期标准、急性生理与慢性健康状况评分Ⅱ（APACHE1I）和序贯器官衰竭评估（SOFA）评分对脓毒症AKI患者的预后评估价值。方法前瞻收集2012—03—01～2013—03—01期间在我院ICU接受治疗的脓毒症患者的临床资料，采用KDIGO标准对脓毒症患者进行AKI诊断和分期；根据患者入ICU第1个24h内的生理指标最差值进行APACHEII和SOFA评分，并用受试者工作特征（ROC）曲线评估3项系统对预后评估的准确性。以Logistic多元回归分析对预后的影响。结果共280例脓毒症患者，占同期ICU住院患者的41．7％（280／670），总体院内死亡率为29．8％。脓毒症肾损伤168例，占脓毒症患者的60％，其中1期76例，死亡率22．4％；2期48例，死亡率37．5％；3期44例，死亡率72．7％。脓毒症肾损伤患者的APACHEⅡ及SOFA评分均高于非AKI患者（P〈0．05）。Logistic多元回归分析显示，APACHEII评分〉22分（OR：4．50），KDIGO分期1、2、3期（OR值分别为2．31、7．44、45．00）是脓毒症并AKI患者院内死亡的独立预测指标。结论KDIGO诊断标准与APACHEII、SOFA评分对脓毒症肾损伤患者整体预后都有较好的预测价值。

Objective To explore the prognostic value of kidney disease： improving global outcomes（KDIGO） criteria, acute physiology and chronic health evaluation II （APACHE II ）and sequential organ failure assessment （SOFA） scoring system in acute kidney injury （AKI） caused by sepsis. Methods Clinical data of septic patients who in department of intensive care medicine, Weifang peoples hospital from march 2012 to march 2013 were prospectively collected. AKI patients was classified by KDIGO staging system. APACHE II and SOFA scores were evaluated according to the worst value of physiologic variables in the 1st 24 h after ICU admission. Discrimination and calibration of these three models were assessed by receiver operating characteristic （ROC）curve. Besides, their effects on inhospital mortality were evaluated by multiple Logistic regression analysis. Results Of the 280 admissions. Accounted for 41.7% of all hospitalized patients with ICU during this period （280/670）, the overall mortality was 29.8%. 168 patients developed AKI and the incidence was 60%, including phase I： 76 eases, mortality rate was 22.4% ; phase 2：48 patients, mortality rate was 37.5% ; phase 3：44 cases, mortality rate was 72.7%. APACHE II , SOFA score of Septic patients with AKI were higher than of non - AKI patients （ P 〈 0.05 ）. In Septic patients with AKI, Logistic multivariate regression analysis showed that APACHE II more than 22 points （ OR = 4.50）, the KDIGO stage 1, 2, 3 （OR values were 2. 31, 2. 31, 45 ）, were an independent predictor of in - hospital deaths. Conchmion KDIGO criteria, APACHE II and SOFA scoring system all present good discrimination and calibration in predicting patients outcome. APACHE lI 922 along with KDIGO stage 1, 2, 3 are found to be the independent predictors of in - hospital mortality.