RIFLE AKIN和KDIGO 3种急性肾损伤诊断标准在急性心肌梗死患者中的应用比较

Comparison of RIFLE,AKIN and KDIGO diagnostic criteria for acute kidney injury in patients with acute myocardial infarction

目的比较风险、损伤、衰竭、失功能、终末期肾病(RIFLE)、急性肾损伤网络(AKIN)和改善全球肾脏病预后组织(KDIGO)3种急性肾损伤(AKI)诊断标准对急性心肌梗死(AMI)患者AKI的诊断效率及其对早期(住院期间)死亡的预测能力。方法回顾性分析2011年7月至2016年12月北京安贞医院收治住院的4610例AMI患者的临床资料。根据RIFLE、AKIN和KDIGO 3种标准统计住院期间AKI发生率,应用二元logistic回归分析住院死亡的危险因素,应用受试者工作特征(ROC)曲线比较3个标准对AMI患者住院死亡的预测准确性,应用Hosmer-Lemeshow拟合曲线来评估模型的拟合优度。结果根据RIFLE、AKIN和KDIGO标准,AMI患者住院期间AKI发生率分别为9.2%、9.9%和12.7%。RIFLE(OR 5.49,95%CI 2.83~10.63,P<0.001)、AKIN(OR 9.74,95%CI 4.86~19.52,P<0.001)和KDIGO(OR 7.69,95%CI 3.87~15.30,P<0.001)标准诊断的AKI均是AMI患者住院死亡的独立危险因素。3种诊断标准预测AMI患者住院死亡的ROC曲线下面积(AUC)分别为0.919、0.918和0.911,3种诊断标准的AUC间差异无统计学意义(P>0.05)。3种诊断标准预测住院死亡的Hosmer-Lemeshow检验均P>0.05。结论KDIGO标准对诊断AMI患者住院期间发生AKI最为敏感。RIFLE、AKIN和KDIGO标准对于预测AMI患者发生住院死亡均具有良好的判别能力。

Objectives To compare the diagnostic efficiency of 3 acute kidney injury(AKI)criteria(RIFLE,AKIN and KDIGO)in patients with acute myocardial infarction(AMI)and their ability in predicting early death(during hospitalization).Methods Clinical data of 4610 patients with AMI admitted to Beijing Anzhen Hospital from July 2011 to December 2016 were retrospectively analyzed.The incidence of AKI was calculated according to the 3 criteria of RIFLE,AKIN and KDIGO.The risk factors of death in hospital were analyzed by binary logistic regression.The prediction accuracy of 3 criteria for death in hospital was compared by the receiver operating characteristic(ROC)curve.The goodness of fit for model was evaluated by Hosmer-Lemeshow-test.Results According to the RIFLE,AKIN and KDIGO criteria,the incidences of AKI in hospital were 9.2%,9.9% and 12.7%,respectively.AKI diagnosed by RIFLE(OR 5.49,95%CI2.83-10.63,P<0.001),AKIN(OR 9.74,95%CI 4.86-19.52,P<0.001),and KDIGO(OR 7.69,95%CI 3.87-15.30,P<0.001)was independent risk factor for hospital death in patients with AMI.The area under the ROC curve(AUC)of RIFLE,AKIN and KDIGO criteria to predict death within hospitalization in AMI patients were 0.919,0.918 and 0.911,respectively,and there was no significant difference among the 3 criteria criteria(P>0.05).The result of HosmerLemeshow test in the 3 stages was not statistically different(P<0.05).Conclusions KDIGO criteria is the most sensitive for the diagnosis of AKI in patients with AMI during hospitalization.RIFLE,AKIN and KDIGO criteria all display adequate discrimination for predicting the inhospital death of AMI patients.