个体化预测脓毒症患者并发急性肾损伤的风险列线图的建立及验证

Establishment and Validation of Risk Nomogram for Individualized Prediction of Acute Kidney Injury in Patients with Sepsis

目的建立脓毒症患者发生急性肾损伤(acute kidney injury,AKI)的早期预测列线图模型及其验证。方法选取2020年1月~2021年12月兰州大学第二医院接收的162例脓毒症患者为建模组,选取2022年1~12月接收的93例脓毒症患者为验证组。将建模组患者分为脓毒症合并AKI组(n=52)和脓毒症未合并AKI组(n=110)。对建模组患者采用Logistic回归分析筛选影响脓毒症患者发生AKI的危险因素;采用R软件构建预测脓毒症患者发生AKI的列线图模型。结果脓毒症合并AKI组和脓毒症未合并AKI组机械通气、重症监护病房(intensive care unit,ICU)住院时间、降钙素原(procalcitonin,PCT)水平、白细胞介素-6(interleukin-6,IL-6)水平、肿瘤坏死因子-α(tumour necrosis factor-α,TNF-α)水平、血乳酸水平比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,机械通气、ICU住院时间≥3天、高水平PCT、高血乳酸水平是脓毒症患者发生AKI的独立危险因素(P<0.05)。基于危险因素采用R软件建立列线图模型,建模组受试者工作特征(receiver operating characteristic,ROC)曲线下面积为0.830,验证组ROC曲线下面积为0.845;根据列线图模型的结果显示,校准曲线预测值与实际值之间基本相符。Hosmer-Lemeshow拟合优度检验结果表明,建模组χ^(2)=7.340,P=0.501;验证组χ^(2)=7.758,P=0.458。结论构建预测ICU脓毒症患者发生AKI的风险列线图模型具有较大临床价值,可在临床上用于指导个体化治疗。

Objective To establish and verify a nomogram model for early prediction of acute kidney injury(AKI)in patients with sepsis.Methods A total of 162 patients with sepsis admitted to the Second Hospital of Lanzhou University from January 2020 to December 2021 were selected as the modeling group,A total of 93 patients with sepsis admitted from January 2022 to December 2022 were selected as the verification group.The patients in the modeling group were divided into the sepsis with AKI group(n=52)and sepsis without AKI group(n=110).Logistic regression analysis was used to screen the risk factors affecting the occurrence of AKI in patients with sepsis in the modeling group;R software was used to construct a nomogram model for predicting the occurrence of AKI in patients with sepsis.Results Mechanical ventilation,hospitalization time of intensive care unit(ICU),procalcitonin(PCT)level,interleukin-6(IL-6)level,and tumor necrosis factor-α(TNF-α)level,and blood lactate level showed statistically significant differences in sepsis with AKI and sepsis without AKI(P<0.05).Multivariate Logistic regression analysis showed that mechanical ventilation,hospitalization time of ICU≥3days,and high PCT level,and high blood lactate level were independent risk factors for the occurrence of AKI in patients with sepsis(P<0.05).Based on the risk factors,a nomogram model was established with R software,and the area under the receiver operating characteristic(ROC)curve was 0.830 in the modeling group,and 0.845 in the validation group.According to the results of the nomogram model,the calibration curves were in general agreement between the predicted values and actual values.The results of the Hosmer-Lemeshow goodness-of-fit test showed that for the modelling groupχ^(2)=7.340,P=0.501,and for the validation groupχ^(2)=7.758,P=0.458.Conclusion The construction of a risk nomogram model for predicting the occurrence of AKI in patients with sepsis in the ICU is of great clinical value,and can be used in the clinic to guide individualised treatment.