弥散性血管内凝血评分系统评分联合C反应蛋白对重症肺炎患者急性肾损伤的预测价值

The predictive value of ISTH score combined with C reactive protein for acute kidney injury in patients with severe pneumonia

目的评价国际血栓与止血委员会的弥散性血管内凝血（DIC）评分系统（ISTH）评分联合c反应蛋白（CRP）在重症肺炎患者急性肾损伤（AKI）中的预测价值。方法回顾性分析我院2011-01—2015-03收治的104例成人重症肺炎患者，根据2012年“改善全球肾脏病预后组织”（KDIGO）指南确立的AKI诊断标准将患者分为非AKI组（56例）及AKI组（48例），比较组间差异。绘制ROC曲线，比较和观察ISTH评分联合CRP、ISTH评分、CRP、APACHEⅡ评分、SOFA评分对重症肺炎患者AKI的预测价值。结果AKI组患者ISTH评分、APACHEⅡ评分、SOFA评分、DIC发生率、CRP等感染炎性指标明显高于非AKI组（均P〈0．05）。5种方法对重症肺炎患者AKI均有预测价值，ISTH评分联合CRP除与CRP的曲线下面积（AUC）差异有统计学意义（P〈0．05）外，与其他三者的AUC比较差异无统计学意义（均P〉0．05）。结论ISTH评分联合CRP检查对重症肺炎患者的AKI具有临床预测价值。

Objective To evaluate the predictive value of ISTH score combined with C reactive protein（CRP） in the diagnosis of acute kidney injury （AKI） in patients with severe pneumonia, Methods A total of 104 patients diagnosed with severe pneumonia admitted to the department of emergency in our hospital between January 1st, 2011 and March 31th, 2015 were retrospectively studied. According to the diagnostic criteria and stage of the guidelines of Kidney Disease： Improving Global Outcomes 2012（ KDIGO -AKI 2012）, patients were divided into non -AKI group （n =56） and AKI group （ n = 48）. Compared analysis was carried out in each index between two groups. ROC curve analysis of the ISTH score combined with CRP, ISTH score, CPR, APACHE Ⅱ score, SOFA score were performed in order to compare and observe the predictive value of these methods. Results There was a significant difference in the APACHE Ⅱ score, SOFA score, ISTH score, the incidence of DIC, CRP and the other infectious inflammatory index between non- AKI group and AKI group（P 〈0.05）. AU of these methods had the predictive value of AKI. There was a significant difference in the areas under the ROC curve between ISTH score combined with CRP and CRP （P 〈0.05）, but there was no significant difference in the areas under the ROC curve among ISTH score combined with CRP with the other methods （P 〉 0.05）. Conclusion ISTH score combined with CRP are valuable for predicting acute kidney injury in patients with severe pneumonia.