液体过负荷与慢性肾脏病患者并发急性肾损伤的相关性分析

Correlation Analysis between Fluid Overload and Acute Kidney Injury in Patients with Chronic Kidney Disease

探讨液体过负荷与CKD患者并发AKI的相关性并建立预测模型评估AKI的发生风险。根据入排标准,选取2016年6月至2020年7月在我院肾内科住院治疗的92例CKD1~4期患者,分为AKI组16例和non-AKI组76例,并收集两组临床资料、实验室检查及24 h出入液量。通过组间比较及Logistic回归分析AKI的相关危险因素并建立预测模型。AKI发生率为17.3%,AKI组在AKI发生前5 d或前7 d平均每日液体入超量及基线肌酐、尿素氮、血氯水平均高于non-AKI组(P<0.05);AKI组心力衰竭、感染及使用利尿剂、β-内酰胺类的比例明显高于non-AKI组(P<0.05)。多因素Logistic回归分析显示AKI发生前5 d平均每日液体入超量每增加1dL,AKI的发生率将增加17.5%,AKI发生前7 d平均每日液体入超量每增加1dL,AKI的发生率将增加19.1%,另外,基线肌酐、血氯亦为CKD患者并发AKI的独立危险因素。AKI发生前7 d平均每日液体入超量与基线肌酐、血氯建立的预测模型1的ROC曲线下面积为0.827,当约登指数为0.586时,敏感度为93.3%,特异度为65.3%。液体过负荷是CKD并发AKI的独立危险因素,液体过负荷联合基线肌酐、血氯建立的预测模型可帮助临床医师评估CKD患者AKI发生的风险。

To explore the correlation between fluid overload and AKI in CKD patients and establish a predictive model to assess the risk of AKI,according to the admission and discharge standards,92 CKD1~4 patients hospitalized in the nephrology department of the authors′hospital from June 2016 to July 2020 were selected and divided into AKI group(16 cases)and non AKI group(76 cases),and clinical data,laboratory tests and 24-hour fluid volume were collected from the two groups.The related risk factors of AKI were analyzed by comparison between groups and logistic regression,and the prediction model was established.The incidence of AKI was 17.3%.The average daily liquid intake,baseline creatinine,urea nitrogen and blood chlorine in AKI group were higher than those in non AKI group 5 or 7 days before AKI(P<0.05);Heart failure,infection and diuretic used in AKI group,the proportion ofβ-lactams was significantly higher than that of non AKI group(P<0.05).Multivariate logistic regression analysis showed that the incidence of AKI would increase by 17.5%for every 1 dL increased in the average daily liquid intake 5 days before the onset of AKI,and by 19.1%for every 1 dL increased in the average daily liquid intake 7 days before the onset of AKI.In addition,baseline creatinine and blood chlorine were also independent risk factors for CKD patients with AKI.The area under the ROC curve of prediction model 1 established by the average daily liquid intake 7 days before AKI and baseline creatinine and blood chlorine was 0.827.When the Yoden index was 0.586,the sensitivity was 93.3%and the specificity was 65.3%.Fluid overload is an independent risk factor of CKD complicated with AKI.The prediction model established by fluid overload combined with baseline creatinine and blood chlorine can help clinicians assess the risk of AKI in CKD patients.