阴离子间隙联合SOFA评分对脓毒症相关急性肾损伤患者28 d死亡风险的预测价值

Predictive value of anion gap combined with SOFA score for 28-day death risk of patients with sepsis-associated acute kidney injury

目的探讨阴离子间隙(AG)联合序贯器官衰竭评估(SOFA)评分对脓毒症相关急性肾损伤(SA-AKI)患者28 d死亡风险的预测价值。方法回顾性选取2020年2月至2022年10月恩施土家族苗族自治州中心医院ICU收治的249例SA-AKI患者为SA-AKI组,根据急性肾损伤(AKI)分期分为Ⅰ期组69例、Ⅱ期组105例、Ⅲ期组75例;另选取同期本院健康体检的65名志愿者为对照组。比较两组研究对象以及不同AKI分期SA-AKI患者AG和SOFA评分,采用多因素logistic回归分析SA-AKI患者住院28 d死亡的危险因素,ROC曲线分析AG、SOFA评分单独及联合预测SA-AKI患者住院28 d死亡的效能。结果SA-AKI组AG和SOFA评分均明显高于对照组(均P<0.01)。SA-AKI患者Ⅱ期组、Ⅲ期组AG和SOFA评分均高于Ⅰ期组(均P<0.05),Ⅲ期组又均高于Ⅱ期组(均P<0.05)。接受连续肾替代治疗(OR=2.869)、AKI分期Ⅲ期(OR=2.149)、高AG(OR=1.677)、高SOFA评分(OR=1.738)均是SA-AKI患者住院28 d死亡的独立危险因素(均P<0.01)。AG和SOFA评分联合预测SA-AKI患者住院28 d死亡的AUC为0.916,分别高于单项预测的0.744、0.826(均P<0.05)。结论SA-AKI患者AG和SOFA评分均升高,且与SA-AKI肾损伤加重和住院28 d死亡风险增加有关,联合AG和SOFA评分有助于提高对SAAKI患者28 d死亡风险的预测效能。

Objective To investigate the predictive value of anion gap(AG)combined with Sequential Organ Failure Assessment(SOFA)score for 28-day death risk of patients with sepsis-associated acute kidney injury(SA-AKI).Methods A total of 249 patients with SA-AKI admitted to the ICU of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from February 2020 to October 2022 were retrospectively selected as the SA-AKI group,and they were further divided into stageⅠgroup(69 cases),stageⅡgroup(105 cases)and stageⅢgroup(75 cases)according to the stage of acute kidney injury(AKI).Another 65 volunteers who underwent physical examination in the same hospital during the same period were selected as the control group.AG and SOFA scores were compared between the two groups of subjects and SA-AKI patients with different AKI stages.Multivariate logistic regression was used to analyze the risk factors for 28-day in hospital death of SA-AKI patients.ROC curve was used to analyze the efficacy of AG and SOFA scores alone and in combination on predicting 28-day in-hospital death of SA-AKI patients.Results The AG and SOFA scores in the SA-AKI group were significantly higher than those of the control group(both P<0.01).The AG and SOFA scores of stagesⅡandⅢgroups were both higher than those of stageⅠgroup(all P<0.05),with those in stageⅢgroup higher than those in stageⅡgroup(all P<0.05).Continuous renal replacement therapy(OR=2.869),AKI stageⅢ(OR=2.149),high AG(OR=1.677),and high SOFA score(OR=1.738)were independent risk factors for 28-day in-hospital death of patients with SA-AKI(all P<0.01).The AUC of AG combined with SOFA score in predicting 28-day indeath of SA-AKI patients was 0.916,which was higher than 0.744 and 0.826 of the prediction with each index,respectively(both P<0.05).Conclusion The AG and SOFA scores of SA-AKI patients are increased,which are related to the aggravation of renal injury and the increased risk of 28-day in-hospital death of SA-AKI patients.The combination of AG and SOFA scores is helpful to improve the predictive efficacy of 28-day death risk of SA-AKI patients.