CAJ | 학술논문

目的分析克利夫兰急性肾功能衰竭评分(Cleveland ARF Score)、心脏术后急性肾功能不全评分(acute kidney injury prediction following elective cardiac surgery,AKICS)、简易肾功能指数评分(Simplified Renal Index,SRI score)三种模型在预测心脏术后发生急性肾功能衰竭中的作用,评价三种模型的预测价值.方法 2009年6月至2010年5月,连续收集了行心脏手术并有完整资料的患者504例纳入研究,分别使用Cleveland、AKICS、SRI评分系统进行校准度和分辨力的评价,分析并比较三种评分系统模型对术后发生急性肾功能衰竭的预测价值.结果 504例中术后需要肾脏替代治疗(renal re-placement therapy,RRT) 16例(3.17％),其中6例死亡(37.5％)；发生肾功能不全27例(5.36％),经治疗后肾功能恢复正常.应用AKICS模型术后需要RRT治疗11例(2.70％),发生肾功能不全25例(6.13％),模型全组预计发生率3.77％.Cleveland评分术后需要RRT治疗16例(3.17％),发生肾功能不全27例(5.36％),模型全组预计发生率0.99％.SRI评分术后需要RRT治疗15例(3.21％),发生肾功能不全24例(5.13％).与预测结果比较,AKICS模型表现出较好的校准度(P=0.922,x2=0.162),Cleveland模型校准度差异有统计学意义(P=0.026,x2=15.644).Cleveland Score、AKICS、SRI 预测术后急性肾功能衰竭需行RRT治疗的ROC曲线下面积分别为0.695、0.732、0.759,术后肾功能不全的ROC曲线下面积分别为0.711、0.753、0.779.结论结果显示,SRI模型预测术后RRT治疗及肾功能不全的实际危险度相关性较好.AKICS模型预测术后肾功能不全的实际危险度相关性较好.SRI模型的校准度及分辨能力均较好,可能较适用于评估患者的相对危险度.AKICS模型对于研究设计及选择治疗方案有一定使用价值.
목적 분석극리부란급성신공능쇠갈평분(Cleveland ARF Score)、심장술후급성신공능불전평분(acute kidney injury prediction following elective cardiac surgery,AKICS)、간역신공능지수평분(Simplified Renal Index,SRI score)삼충모형재예측심장술후발생급성신공능쇠갈중적작용,평개삼충모형적예측개치.방법 2009년6월지2010년5월,련속수집료행심장수술병유완정자료적환자504례납입연구,분별사용Cleveland、AKICS、SRI평분계통진행교준도화분변력적평개,분석병비교삼충평분계통모형대술후발생급성신공능쇠갈적예측개치.결과 504례중술후수요신장체대치료(renal re-placement therapy,RRT) 16례(3.17％),기중6례사망(37.5％)；발생신공능불전27례(5.36％),경치료후신공능회복정상.응용AKICS모형술후수요RRT치료11례(2.70％),발생신공능불전25례(6.13％),모형전조예계발생솔3.77％.Cleveland평분술후수요RRT치료16례(3.17％),발생신공능불전27례(5.36％),모형전조예계발생솔0.99％.SRI평분술후수요RRT치료15례(3.21％),발생신공능불전24례(5.13％).여예측결과비교,AKICS모형표현출교호적교준도(P=0.922,x2=0.162),Cleveland모형교준도차이유통계학의의(P=0.026,x2=15.644).Cleveland Score、AKICS、SRI 예측술후급성신공능쇠갈수행RRT치료적ROC곡선하면적분별위0.695、0.732、0.759,술후신공능불전적ROC곡선하면적분별위0.711、0.753、0.779.결론 결과현시,SRI모형예측술후RRT치료급신공능불전적실제위험도상관성교호.AKICS모형예측술후신공능불전적실제위험도상관성교호.SRI모형적교준도급분변능력균교호,가능교괄용우평고환자적상대위험도.AKICS모형대우연구설계급선택치료방안유일정사용개치.
Objective Acute renal failure (ARF) requiring renal replacement therapy (RRT) was reported in 0.33％to 9.5％ patients after cardiac surgery.This study was designed to assess the clinical usefulness and accuracy of 3 clinical tools for the prediction of ARF after cardiac surgery in Chinese patients.Methods Five hundred and four eligible patients with complete clinical data in our institution received prospective assessment for RRT and acute kidney injury (AKI) between June,2009 and November,2010.The clinical tools used were Cleveland ARF Score,acute kidney injury prediction following elective cardiac surgery(AKICS) and Simplified Renal Index(SRI).Hosmer—Lemeshow goodness-of-fit test was used to estimate the calibration.Discrimination was determined with receiver operating characteristic (ROC) curves and area under a ROC curve (AUC).Results Follow-up was completed in all 504 patients.The overall incidence of postoperative RRT was 3.17％(16/504) with a mortality of 37.5％,and the incidence of AKI was 5.36％ ( 27/504 ).Discrimination for the prediction of RRT and AKI was good for SRI measured with AUROCs:0.759 (95％ CI,0.643-0.874) for RRT and 0.773 (95％ CI,0.677-0.868 ) for AKI.SRI score performed better in terms of discrimination than Cleveland ARF score and AKICS in our study,which did not consist with results reported by other centers.Conclusion SRI scoring system is the most useful among three tools for predicting postoperative RRT and should be the first choice in Chinese patients for whom a cardiac surgery is planned.It can also be used in predicting the composite end point of AKI with an extended application in patients at risk for postoperative kidney dysfunction.