HELENICC评分预测脓毒症相关急性肾损伤行持续肾脏替代治疗患者早期病死率的价值

Value of HELENICC score in predicting early mortality of septic-related acute kidney injury patients with continuous renal replacement therapy

目的分析肝衰竭、乳酸、去甲肾上腺素、医疗条件和肌酐评分(HELENICC评分)对脓毒症相关急性肾损伤(S-AKI)行持续肾脏替代治疗(CRRT)患者早期病死率的预测价值。方法选取2019年1月—2022年12月入住本院重症监护室(ICU)的S-AKI行CRRT的99例患者为研究对象,根据7 d死亡率分为存活组55例和死亡组44例。CRRT开始时,评估2组急性生理与慢性健康评分Ⅱ(APACHEⅡ评分)、序贯性器官功能衰竭评分(SOFA评分)、简化急性生理学评分3(SAPS3评分)以及HELENICC评分,并计算APACHEⅡ评分、SOFA评分、SAPS3评分、HELENICC评分的受试者工作特征(ROC)曲线的曲线下面积(AUC)。结果死亡组ICU机械通气时间、ICU住院时间长于存活组,差异有统计学意义(P<0.01);死亡组去甲肾上腺素剂量、乳酸、肌酐值、肝衰竭发生比率、医疗条件、APACHEⅡ评分、SOFA评分、SAPS3评分、HELENICC评分均高于存活组,差异有统计学意义(P<0.05或P<0.01)。随着HELENICC评分等级增高,病死率也逐渐升高,HELENICC评分等级与病死率存在线性相关性(OR=3.17,95%CI:0.46~0.67,P<0.05)。APACHEⅡ评分的AUC是0.729(95%CI:0.630~0.827,P<0.01),SOFA评分的AUC是0.638(95%CI:0.521~0.754,P=0.019),SAPS3评分的AUC是0.819(95%CI:0.737~0.901,P<0.01),HELENICC评分的AUC是0.828(95%CI:0.743~0.914,P<0.01)。结论HELENICC评分可较好地预测ICU中S-AKI行CRRT的患者的早期病死率。

Objective To analyze the value of the Hepatic Failure,Lactate,Norepinephrine,Medical Condition and Creatinine score(HELENICC score)in predicting early mortality of sepsis-related acute kidney injury(S-AKI)patients with continuous renal replacement therapy(CRRT).Methods From January 2019 to December 2022,99 S-AKI patients with CRRT in the Intensive Care Unit(ICU)of the authors′hospital were selected as research objects,and they were divided into survival group(n=55)and death group(n=44)according to 7-day mortality.At the beginning of the CRRT,the Acute Physiology and Chronic Health EvaluationⅡscore(APACHEⅡscore),the Sequential Organ Failure Assessment score(SOFA score),the Simplified Acute Physiology Score 3(SAPS3 score)and HELENICC score were evaluated in both groups,and the values of the area under the curve(AUC)of the receiver operating characteristic(ROC)curve for APACHEⅡscore,SOFA score,SAPS3 score and HELENICC score were calculated.Results In the death group,the mechanical ventilation time and length of hospital stay in ICU were significantly longer than those in the survival group(P<0.01);in the death group,the dose of adrenaline,lactate level,creatinine level,ratio of cases with liver failure,medical condition,APACHEⅡscore,SOFA score,SAPS3 score and HELENICC score were significantly higher than those in the survival group(P<0.05 or P<0.01).With the increasing of the HELENICC score,the mortality increased gradually,and there was a linear correlation between the HELENICC score grade and the mortality(OR=3.17,95%CI,0.46 to 0.67,P<0.05).The AUC was 0.729 for APACHEⅡscore(95%CI,0.630 to 0.827,P<0.01),0.638 for SOFA score(95%CI,0.521 to 0.754,P=0.019),0.819 for SAPS3 score(95%CI,0.737 to 0.901,P<0.01),and 0.828 for HELENICC score(95%CI,0.743 to 0.914,P<0.01).Conclusion HELENICC score can well predict the early mortality of S-AKI patients with CRRT in the ICU.