血小板正常患者经皮肾穿刺活检术后的出血并发症的危险因素和预测模型构建

Risk factors for bleeding complication after percutaneous renal biopsy in patients with normal platelet count

目的探讨将血小板≥110×10^(9)L作为肾穿刺活检指征的人群肾穿刺后出现出血并发症的危险因素并构建预测模型。方法回顾性分析2017年6月13日至2018年12月27日广东省人民医院行经皮肾穿刺活检的1036例成人患者的临床资料。定义需要临床干预的出血为显性出血,定义输注红细胞或介入治疗或肾脏手术或死亡为大出血。结果纳人研究的1036例患者中,显性出血和大出血的发生率分别为3.76%(39/1036)和1.54%(16/1036)。在多变量logistic回归模型中,与显性出血相关的变量为估算肾小球滤过率<60 mL·(min.1.73 m^(2))^(-1)、红细胞压积<0.4和肾长/身高<0.066,其优势比分别为2.16(95%CI:1.08~4.34)、4.04(95%CI:1.39-11.76)和2.65(95%CI:1.08〜6.50);与大出血独立相关的变量是血红蛋白<100 g/L和肾长/身高<0.066,其优势比分别为10.29(95%CI:3.65~28.95)和7.87(95%CI:1.02~60.43)。进一步用列线图可视化这些变量构建预测出血模型。经受试者工作特征曲线检验,显性出血和大出血模型的曲线下面积分别为0.13(95%CI:0.682~0.742)和0.802(95%CI:0.774~0.827),显示了良好的临床价值。结论对于血小板正常的患者,基线肾功能、贫血和肾脏相对大小是肾穿刺后出血并发症的独立危险因素。

Objective Recently,platelets 110×10^(9)/L was taken as the indication of renal needle biopsy in our unit.To identify the risk factors for bleeding complication after percutaneous renal biopsy in patients with normal platelet count and built predictive models.Methods We conducted a retrospective study in adult patients undergoing percutaneous renal biopsy in Guangdong provincial peoples hospital from June 13,2017 to December 27,2018.Those requiring clinical intervention was defined as apparent bleeding,while red blood cell infusion,interventional therapy,kidney surgery,or death was defined as major bleeding.Results Total 1036 patients were enrolled.Among them,3.76%patients had apparent bleeding and major bleeding occurred in 1.54%patients.Multiple logistic regression mode demonstrated that estimated glomerular filtration rate<60 mL·(min 1.73 m^(2))^(-1),hematocrit<0.4,and kidney length/height<0.066 were risk factors for apparent bleeding,with an odds ratios(ORs)of 2.16(95%CI:1.084.34),4.04(95%CI:1.39-11.76)and 2.65(95%CI:1.08-6.50),respectively.Hemoglobin<100 g/L and kidney length/height<0.066 were independently associated with major bleeding,with ORs of 10.29(95%CI:3.65-28.95)and 7.87(95%CI:1.02-60.43).Predictive bleeding models from the logistic analysis were further visualized using nomogram.These models showed good clinical performances,which were evaluated by the receiver operating characteristic curve.The areas under the curve were 0.713(95%CI:0.682-0.742)for the apparent bleeding and 0.802(95%CI:0.774-0.827)for the major bleeding,respectively.Conclusions For patients with normal platelets,baseline renal function,anemia,and relative kidney size are independent risk factors for bleeding complication after percutaneous renal biopsy.