急性缺血性脑卒中患者急性肾损伤发生的危险因素分析及Nomogram预测模型的构建

RISK FACTORS FOR ACUTE KIDNEY INJURY IN PATIENTS WITH ACUTE ISCHEMIC STROKE AND CONSTRUCTION OF A NOMOGRAM PREDICTIVE MODEL

目的分析急性缺血性脑卒中(acute ischemic stroke,AIS)患者急性肾损伤(acute kidney injury,AKI)发生的危险因素并构建Nomogram预测模型。方法以2020年1月-2021年6月在我院住院的1633例AIS患者为研究对象,根据是否发生AKI分为AKI组和非AKI组,利用Lasso-Logistic回归分析AIS患者发生AKI的危险因素,构建Nomogram预测模型,采用受试者工作特征曲线(ROC)、一致性指数(C-Index)、校准曲线及决策曲线分析(DCA)评价模型预测价值。结果1633例AIS患者中,238例(14.57%)患者发生了AKI。Lasso-Logistic回归分析结果显示,中性粒细胞升高、凝血酶原时间延长、乳酸脱氢酶升高、肾小球滤过率降低、有输血史、合并慢性肾脏病、使用抗生素、使用双嘧达莫、使用利尿剂、使用β受体阻滞剂是AIS患者发生AKI的独立危险因素(P<0.05)。Nomogram预测模型的ROC曲线下面积为0.797(95%CI=0.769~0.866,P<0.01),内部验证的C-Index为0.762(95%CI=0.761~0.762,P<0.01)。校准曲线显示模型的一致性良好,DCA提示模型具有一定的临床实用性。结论本研究明确了AIS患者发生AKI的危险因素,并构建了Nomogram预测模型,有助于临床早期识别和防治AKI,以改善患者预后。

Objective To investigate the risk factors for acute kidney injury(AKI)in patients with acute ischemic stroke(AIS),and to construct a Nomogram predictive model.Methods A total of 1633 patients with AIS who were hospitalized in our hospital from January 2020 to June 2021 were enrolled as subjects,and according to the presence or absence of AKI,they were divided into AKI group and non-AKI group.Lasso-Logistic regression analysis was used to investigate the risk factors for AKI in patients with AIS.A Nomogram predictive model was constructed,and the receiver operating characteristic(ROC)curve,index of concordance(C-Index),calibration curve,and decision curve analysis(DCA)were used to evaluate the predictive value of this model.Results Among the 1633 patients with AIS patients,238(14.57%)developed AKI.The Lasso-Logistic regression analysis showed that the increase in neutrophils,prolongation of prothrombin time,the increase in lactate dehydrogenase,the reduction in estimated glomerular filtration rate,history of blood transfusion,comorbidity of chronic kidney disease,and use of antibiotics,dipyridamole,diuretics,andβ-receptor blocker were independent risk factors for AKI in AIS patients(P<0.05).The Nomogram predictive model had an area under the ROC curve of 0.797(95%CI=0.769-0.866,P<0.01),and the C-Index of internal validation was 0.762(95%CI=0.761-0.762,P<0.01).The calibration curve showed that the model had good consistency,and DCA showed that the model had certain clinical practicability.Conclusion This study clarifies the risk factors for AKI in AIS patients and constructs a Nomogram predictive model,which may facilitate the early identification,prevention,and treatment of AKI and improve patient prognosis.