凝血SOFA评分对严重脓毒症相关急性肾损伤患者预后的预测价值

Value of baseline SOFA coagulation score for prediction of prognosis in patients with severe sptic AKI

目的评估基础凝血序贯器官衰竭评估(SOFA)评分对需要持续性肾替代治疗(CRRT)的严重脓毒症相关急性肾损伤(S-AKI)患者预后的预测价值。方法回顾性分析2017年1月至2020年10月首都医科大学附属北京友谊医院ICU收治的180例诊断为S-AKI且接受CRRT患者的临床资料,根据基础凝血SOFA评分分为凝血SOFA评分正常组(凝血SOFA评分=0)和凝血SOFA评分异常组(凝血SOFA评分≥1),主要结局指标为CRRT启动后60 d全因病死率。采用多因素Cox回归模型分析基础凝血SOFA评分及其他因素对临床预后的影响。结果本研究共纳入180例患者,凝血SOFA评分正常组66例,凝血SOFA评分异常组114例。凝血SOFA评分正常组60 d病死率为45.5%(30/66),凝血SOFA评分异常组60 d病死率为64.0%(73/114),2组间病死率比较差异有统计学意义(P=0.015)。2组间ICU住院时间(P=0.870)及肾替代时长(P=0.270)比较差异无统计学意义(P>0.05)。多因素Cox回归分析显示,在校正了其他因素的影响后,凝血SOFA评分异常是接受CRRT的S-AKI患者60 d死亡的独立危险因素(HR=1.616,P=0.034)。结论异常的凝血SOFA评分在需要CRRT的S-AKI患者中是常见的现象,开始CRRT前异常的凝血SOFA评分与60 d病死率增加显著相关。

Objective To evaluate the prognostic value of baseline SOFA coagulation score(SOFA-CS)in patients with septic acute kidney injury(S-AKI)requiring continuous renal replacement therapy(CRRT).Methods This retrospective study included 180 patients with S-AKI receiving CRRT from January 2017 to October 2020 in the Department of Critical Care Medicine of Beijing Friendship Hospital affiliated to Capital Medical University.Patients were divided into normal SOFA-CS group(SOFA-CS=0)and abnormal SOFA-CS group(SOFA-CS≥1).The primary outcome was all-cause mortality at 60 days after initiation of CRRT.The association between baseline SOFA-CS,process of care,and clinical outcomes were analysed using multivariate Cox model adjusted for baseline variables.Results Among 180 S-AKI patients,66 patients had normal SOFA-CS at baseline,while 114 patients had an abnormal SOFA-CS.The 60-day mortality rate in abnormal SOFA-CS group was higher than that in normal SOFA-CS group(45.5%vs 64.0%,P=0.015).There was no significant difference in the length of ICU stay(P=0.870)and duration of CRRT(P=0.270)between two groups.Multivariable Cox regression analysis showed that an abnormal SOFA-CS was independently associated with an increased risk of death at 60 days(HR=1.616,P=0.034).Conclusion Abnormal coagulation is a common phenomenon in patients with S-AKI receiving CRRT.An abnormal baseline SOFA coagulation score is associated with increased mortality at 60 days.