呋塞米与甘露醇联用致脑水肿患者急性肾损伤风险因素分析及预测

Risk factor analysis and prediction of acute kidney injury in patients with cerebral edema treated with furosemide and mannitol

目的分析脑水肿患者联合应用呋塞米与甘露醇发生急性肾损伤(AKI)的风险因素并建立风险预测模型,提高临床用药安全性。方法回顾性分析联合应用呋塞米和甘露醇的157例脑水肿住院患者资料,对可能发生AKI不良反应的危险因素进行单因素分析及多因素logistic回归分析,并在此基础上建立发生AKI的风险预测模型,采用受试者工作特征(ROC)曲线评价预测模型。结果联合应用呋塞米和甘露醇的157例脑水肿住院患者发生AKI 18例(11.5%),年龄、尿素氮和合用地高辛是发生AKI的独立风险因素。建立logistic回归模型logit(P)=0.049 X_(1)+2.205 X_(2)+2.638 X_(3)-1.138,其中X_(1)为年龄,X_(2)为合用地高辛(使用为1,未使用为0),X_(3)为尿素氮值,进一步得到AKI的联合预测因子Y=X_(1)+45.00 X_(2)+53.84 X_(3)。构建各危险因素及联合预测因子的ROC曲线,发现联合预测因子的曲线下面积最大,其在ROC曲线对应的最佳截断值为442.5。结论高龄、尿素氮高、合用地高辛是脑水肿患者联合应用呋塞米与甘露醇发生AKI的独立危险因素,拟合建立风险预测模型有助于AKI风险的评估。

AIM To analyze the risk factors of acute kidney injury(AKI)in patients with cerebral edema treated with furosemide and mannitol and establish a risk prediction model to improve the safety of clinical medication.METHODS The data of 157 inpatients with cerebral edema who were treated with furosemide and mannitol were retrospectively analyzed.Univariate analysis and multivariate logistic regression analysis were performed to determine the risk factors of AKI induced by furosemide and mannitol,and the risk prediction model for AKI was established.Then the receiver operating characteristic(ROC)curve was used to evaluate the model.RESULTS AKI occurred in 18(11.5%)of 157 inpatients with cerebral edema treated with furosemide and mannitol.Age,urea nitrogen and combined digoxin were independent risk factors for AKI.Logistic regression model was established by integrating the three risk factors:logit(P)=0.049 X_(1)+2.205 X_(2)+2.638 X_(3)-1.138,where X_(1)was age,X_(2)was combined digoxin(used 1,unused 0),X_(3)was urea nitrogen value,and the combined predictor was obtained:Y=X_(1)+45.00 X_(2)+53.84 X_(3).By constructing ROC curves of the three risk factors and combined predictor.It was found that the area under the curve of combined predictor was the largest and the optimal cut-off value corresponding to the ROC curve was 442.5.CONCLUSION Older age,high urea nitrogen and combination of digoxin are independent risk factors for AKI in patients with cerebral edema treated with furosemide and mannitol.Fitting of the three factors to establish a risk prediction model is helpful to assess the risk of AKI.