AFR在脓毒症患者急性肾损伤发生及预后中的价值研究

Study on the analysis of the predictive value of AFR on acute kidney injury occurrence and prognosis in the patients with sepsis

目的分析清蛋白/纤维蛋白原比值(AFR)在脓毒症患者急性肾损伤(AKI)事件发生及预后预测中的临床价值。方法选取该院ICU病房2016年6月至2019年6月收治的170例脓毒症患者为研究对象,分为AKI组(n=52)和无AKI组(n=118),比较两组基线资料及实验室指标。采用多因素logistic回归分析探讨AKI事件发生危险因素,受试者工作特征(ROC)曲线评估AFR对AKI事件的预测价值,Kaplan-Meier曲线分析AFR与预后的关系。结果AKI组年龄、急性生理学及慢性健康状况评分系统(APACHEⅡ)评分、序贯器官衰竭的评估(SOFA)评分、入住ICU时间、机械通气、输血、休克发生率、死亡率、C反应蛋白(CRP)、白细胞(WBC)、血肌酐(Cr)、乳酸脱氢酶(LDH)水平均明显高于无AKI组,而AFR明显低于无AKI组(P<0.05);单因素和多因素logistic回归分析结构提示,AFR(OR=1.39,95%CI:1.07~1.85,P=0.021)和休克(OR=1.85,95%CI:1.14~2.89,P=0.033)是脓毒症患者发生AKI的2个独立危险因素;ROC曲线提示AFR能够有效预测脓毒症患者AKI事件的发生(AUC:0.766,P<0.05);AFR低表达的患者(AFR≤9.7)30 d总生存率明显高于AFR高表达患者(AFR>9.7,P<0.05)。结论AFR是脓毒症患者AKI事件发生及脓毒症患者预后预测的独立危险因素。

Objective To analyze the clinical value of albumin-to-fibrinogen ratio(AFR)on acute kidney injury(AKI)occurrence and prognosis in the patients with sepsis.Methods A total of 170 patients with sepsis received treatment at intensive care unit(ICU)of this hospital from June 2016 to June 2019 were chosen.They were divided into the AKI group and the non-AKI group,the general information and the laboratory index test results were compared.Multivariate logistic regression analysis was used to explore the risk factors for AKI events.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of AFR for AKI events.The Kaplan-Meier curve was used to analyze the relationship between AFR and prognosis.Results The age,acute physiology and chronic health status scoring system(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,ICU admission time,mechanical ventilation,blood transfusion,shock incidence,mortality,C-reactive protein(CRP),white blood cell(WBC),serum creatinine(Cr),and lactate dehydrogenase(LDH)levels in the AKI group were significantly higher than those in the non-AKI group,while the AFR value was significantly lower than that in the non-AKI group(P<0.05).Univariate and multivariate logistic regression analysis showed that AFR(OR=1.39,95%CI:1.07-1.85,P=0.021)and shock(OR=1.85,95%CI:1.14-2.89,P=0.033)were two independent risk factors of AKI occurrence in the sepsis patients.ROC curve indicates that AFR could effectively predict the occurrence of AKI events in patients with sepsis(AUC:0.766,P<0.05).The 30-day total survival rate in the sepsis patients with AFR≤9.7 was higher than that in the sepsis patients with AFR>9.7(P<0.05).Conclusion AFR is the independent risk factor of AKI occurrence and prognosis in the sepsis patients.