查尔森合并症指数对合并急性肾损伤并接受连续肾脏替代治疗的脓毒症患者死亡风险的评估价值

Assessing the value of charlson comorbidity index for mortality risk in sepsis patients with acute kidney injury undergoing continuous renal replacement therapy

目的:探讨查尔森合并症指数(CCI)对合并急性肾损伤(AKI)并接受连续肾脏替代治疗(CRRT)的脓毒症患者28 d和90 d死亡风险的评估价值。方法:回顾性连续收集2009年1月-2016年9月韩国Health System Severance医院和Ilsan医院ICU中合并AKI并接受CRRT的脓毒症患者。收集CRRT启动时患者的人口学和临床资料、生化指标、CCI评分、SOFA评分、APACHEⅡ评分,CRRT启动后2 h尿量和总滤出量等数据。采用Kaplan-Meier(K-M)生存曲线、Log-Rank检验、比例风险回归模型(Cox)和趋势性检验分析CCI对28 d和90 d死亡的独立作用,同时采用分层分析和交互作用检验进行亚组分析。结果:本研究最终纳入794例合并AKI并行CRRT的脓毒症患者。K-M曲线和Log-rank检验显示高分CCI患者28 d和90 d死亡率显著高于低分CCI患者。经有向无环图和效应改变法调整混杂后多因素Cox回归和趋势性检验显示CCI与28 d和90 d死亡独立正相关(28 d死亡HR=1.05,95%CI:1.01~1.09,P=0.0155,90 d死亡HR=1.05,95%CI:1.01~1.09,P=0.0080),且两者之间存在显著线性趋势关系(趋势性检验P<0.05)。分层和交互作用检验发现MAP与CCI对90 d死亡存在显著交互作用。结论:CCI与AKI行CRRT的脓毒症患者28 d和90 d死亡风险独立正相关。

Objective:To investigate the value of Charlson Comorbidity Index(CCI)in assessing the risk of death on day 28 and 90 in sepsis patients with acute renal injury(AKI)and continuous renal replacement therapy(CRRT).Methods:Retrospectively collected patients with sepsis undergoing CRRT in the ICU of Health System Severance Hospital andⅡsan Hospital in Korea from January 2009 to September 2016.The demographic and clinical data,biochemical indicators,CCI score,SOFA score,APACHEⅡscore,and urine output at two hours and total filtration volume were collected after CRRT initiation.Kaplan-Meier(K-M)survival curve,Log-rank test,proportional hazard regression model(Cox)and trend test were used to analyze the independent effect of CCI on day 28 and 90 mortality.In addition,stratified analysis and interaction test were used for subgroup analysis.Results:Seven hundred and ninty-four sepsis patients with AKI undergoing CRRT were finally included in this study.K-M curve and Log-rank test revealed the mortality rate in patients with high CCI was significantly higher than that in patients with low CCI on day 28 and 90.After adjustment for potential confounders by directed acyclic graph and effect change methods,multivariate Cox regression and trend test showed CCI was independently positively correlated with day 28 and 90 mortality(28 day mortality:HR=1.05,95%CI:1.01-1.09,P=0.0155;90-day mortality:HR=1.05,95%CI:1.01-1.09,P=0.0080).Also,there was a significant linear trend relationship between them(trend test P<0.05).The stratification and interaction test showed that there was a significant interaction between map and CCI on the 90 th day of death.Conclusion:CCI is independently and positively correlated with the risk of death on days 28 and 90 in sepsis patients with AKI undergoing CRRT.