心脏外科手术后急性肾损伤及其预后的五种评分模型在中国患者的验证研究

Validation of 5 prediction models for acute kidney injury and its outcome after cardiac surgery procedures in Chinese patients

目的研究AKICS、Cleveland、SRI、Mehta和EURO评分模型在心脏外科手术后急性肾损伤（AKI）、需肾脏替代治疗的AKI（RRT—AKI）和死亡的预测价值，比较不同模型的预测能力。方法连续收集2010年5月至2011年1月在复旦大学附属中山医院接受心脏外科手术的患者1067例，分别评价5种评分模型对术后AKI（AKICS评分）、RRT—AKI（Cleveland、SRI和Mehta评分）和死亡（EURO评分）的预测价值，以分辨力（操作者曲线下面积，AUROC）和校准度（Hosmer—Lemeshow拟合优度检验）表示。结果1067例患者中发生AKI217例（20．34％），其中137例（63．13％）治疗后。肾功能完全恢复；RRT—AKI38例（3．56％）；AKI和RRT—AKI患者的病死率分别为9．68％（21／217）和44．73％（17／38），总体病死率为3．28％（35／1067）。预测AKI方面，AKICS模型的分辨力和校准度均较低。预测RRT—AKI方面，Cleveland模型的分辨力和校准度均达到要求，但RRT—AKI的预测值明显低于实际值（1．70％比3．86％），Metha模型的分辨力较低，而SRI模型的校准度较低。EURO模型预测死亡的分辨力和校准度均较低。结论按照目前AKI诊断标准，上述5种模型均不能准确预测心脏外科手术后AKI的发生。Cleveland模型在预测RRT—AKI方面有一定作用，但预测值与实际值仍然有较大差别。EURO评分不能准确预测死亡风险。

Objective To assess the clinical usefulness and value of the 5 models for the prediction of acute kidney injury （AKI）, severe AKI which renal replacement treatment was needed （RRT-AKI） and death after cardiac surgery procedures in Chinese patients. Methods One thousand and sixty- seven patients who undelavent cardiac surgery procedures in the department of cardiac surgery in the Zhongshan Hospital, Fudan University between May 2010 and January 2011 were involved in this research. The predicting value for AKI （AKICS）, RRT-AKI （Cleveland, SRI and Mehta score） and death （EURO score）after cardiac surgery procedures was evaluated by Hosmer-Leineshow goodness-of-fit test for the calibration and area under receiver operation characteristic curve （AUROC） for the discrimination. Results The incidence of AKI was 20.34%（217/1067）, and 63.13% of theirrenal function recovered completely. The incidence of RRT-AKI was 3.56%（38/1067） and the mortality of AKI and RRT-AKI was 9.68% （21/217） and 44.73% （17/38） respectively. The total mortality was 3.28% （ 35/1067 ）. The discrimination and calibration for the prediction of AKI of AKICS were low. For the prediction of RRT-AKI, the discrimination and calibration of Cleveland score were high enough, but the predicated value was lower than the real value （1.70% vs 3.86%）. The discrimination of Mehta score and the calibration of SRI were low. The discrimination and calibration for the prediction of death of EURO score was low. Conclusion According to the 2012 KDIGO AKI definition, none of the 5 models above is good at predicting AKI after cardiac surgery procedures. Cleveland score has been validated to have a proper impact on predicting RRT- AKI after cardiac surgery procedures, but the predicting value is still in doubt. EURO score has been validated to have an inaccurate predicting value for death after cardiac surgery procedures.