强离子隙对脓毒症AKI损伤程度的预测价值

Application value of strong ion gap in prediction of AKI injury degree in sepsis

目的探讨强离子隙(SIG)对脓毒症急性肾损伤(AKI)损伤程度的预测价值,为脓毒症AKI的诊疗和恢复情况提供参考依据。方法选取2018年10月~2020年10月我院重症监护室收治的脓毒症患者332例,依据是否出现AKI分为观察组(n=174)和对照组(n=158),其中观察组依据AKI分级标准分为1、2、3期。评估观察组各期SIG的水平情况、PSIG与急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分、住院时间、血清肌酐(SCr)三者相关性,利用受试者工作特征曲线(ROC)评估SIG、APACHEⅡ评分、SCr对脓毒症AKI损伤程度预测价值。结果SIG与APACHEⅡ评分、住院时间、SCr三者均呈现显著的正相关性,Pearson相关性分析结果显示,相关性分别为0.4780、0.2924、0.9700。SIG对脓毒症AKI损伤程度预测的灵敏度、特异性、准确率分别为75.00%、93.03%、90.82%,SCr相应的数值分别为81.82%、90.91%、89.80%,APACHEⅡ相应的数值分别为55.56%、97.75%、93.88%。SIG、SCr、APACHEⅡ三种指标的AUC分别为90.2%、82.6%、65.8%(P<0.05)。结论SIG与APACHEⅡ评分和SCr呈现显著的正相关性,且SIG对脓毒症AKI损伤程度预测的灵敏度、特异性、准确率均更高。

Objective To explore the predictive value of strong ion gap on the severity of septic AKI injury,and to provide reference for the diagnosis,treatment and recovery of septic AKI.Methods 322 patients with sepsis admitted to ICU of our hospital from October 2018 to October 2020 were selected and divided into experimental group and control group according to whether AKI occurred.The experimental group was divided into three stages according to the stage.The level of SIG,the correlation between PSIG and APACHEⅡscore,length of hospital stay,and SCR in the three groups were evaluated.The predictive value of SIG,APACHEⅡscore,and SCR in the severity of toxic AKI was evaluated by the receiver operating characteristic curve.Results Sig was positively correlated with APACHEⅡscore,length of stay and SCR.Pearson correlation analysis showed that the correlation was 0.4780,0.2924 and 0.9700 respectively.The sensitivity,specificity and accuracy of SIG were 75.00%,93.03%and 90.82%respectively.The corresponding values of SCR were 81.82%,90.91%and 89.80%respectively.The corresponding values of APACHEⅡwere 55.56%,97.75%and 93.88%respectively.The AUC of SIG,SCR and APACHEⅡwere 90.2%,82.6%and 65.8%respectively.Conclusion Sig is positively correlated with APACHEⅡscore and SCR,and SIG has higher sensitivity,specificity and accuracy in predicting the severity of AKI injury in sepsis.