2022 年第 9 期 第 17 卷

创伤出血性休克患者并发急性肾损伤的危险因素分析及相关指标的预测价值评估

Risk factors for acute kidney injury in patients with traumatic hemorrhagic shock and predictive value of associated indicators

作者：解鹏1李纾2赵秀娟1郭辅政1薛海岩1王振洲1朱凤雪1

英文作者：Xie Peng1 Li Shu2 Zhao Xiujuan1 Guo Fuzheng1 Xue Haiyan1 Wang Zhenzhou1 Zhu Fengxue1

单位：1国家创伤医学中心北京大学人民医院创伤救治中心，北京100044；2北京大学人民医院重症医学科，北京100044

英文单位：1National Center for Trauma Medicine Trauma Treatment Center， Peking University People′s Hospital Beijing 100044 China; 2Department of Critical Care Medicine Peking University People′s Hospital Beijing 100044 China

关键词：创伤出血性休克；急性肾损伤；危险因素

英文关键词：Traumatichemorrhagicshock;Acutekidneyinjury;Riskfactors

• 摘要：

• 目的 探讨创伤出血性休克患者并发急性肾损伤（AKI）的危险因素，并评估相关指标的预测价值。方法  回顾性分析2012年11月至2021年8月北京大学人民医院收治的创伤出血性休克患者的临床资料。根据院内是否并发AKI，将所有患者分为AKI组与非AKI组。比较2组患者的临床资料。采用二元多因素Logistic回归模型分析创伤出血性休克患者并发AKI的危险因素，受试者工作特征曲线评估相关指标对创伤出血性休克患者并发AKI的预测价值。结果  本研究共纳入患者286例，其中AKI组患者79例，非AKI组患者207例。AKI组年龄、砸压伤比例、急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分及D-二聚体水平均高于非AKI组，平均动脉压、血红蛋白水平均低于非AKI组，差异均有统计学意义（均P＜0.05）。二元多因素Logistic回归分析结果显示，年龄及APACHE Ⅱ评分是创伤出血性休克患者并发AKI的独立危险因素（均P＜0.001）。年龄预测创伤出血性休克患者并发AKI的曲线下面积（AUC）为0.656（95%置信区间：0.585~0.727，P＜0.001），最佳截断值为76.50岁，敏感度为53.2%，特异度为72.5%，约登指数为0.26。APACHE Ⅱ评分预测的AUC为0.696（95%置信区间：0.629~0.764，P＜0.001），最佳截断值为18.50分，敏感度为60.8%，特异度为68.1%，约登指数为0.29。结论 年龄及APACHE Ⅱ评分是创伤出血性休克患者并发AKI的独立危险因素，二者对创伤出血性休克患者并发AKI具有一定的预测价值。

• bjective  To explore the risk factors for acute kidney injury (AKI) in patients with traumatic hemorrhagic shock, and to evaluate the predictive value of associated indicators. Methods  The clinical data of patients with traumatic hemorrhagic shock admitted to Peking University People′s Hospital from November 2012 to August 2021 were retrospectively analyzed. The patients with traumatic hemorrhagic shock complicated with AKI were included in the AKI group, and those without AKI were included in the non-AKI group. The clinical data were compared between the two groups. Binary multivariate Logistic regression model was used to analyze the risk factors for AKI in patients with traumatic hemorrhagic shock. Receiver operating characteristic curve was used to evaluate the predictive value of associated indicators for AKI in patients with traumatic hemorrhagic shock. Results  There were 286 patients enrolled in this study, including 79 cases in AKI group and 207 cases in non-AKI group. The age, rate of crush injury, acute physiology and chronic health evaluation scoring system Ⅱ (APACHE Ⅱ) score and the level of D-dimer in AKI group were higher than those in non-AKI group, and levels of mean arterial pressure and hemoglobin in AKI group were lower than those in non-AKI group (all P<0.05). Binary multivariate Logistic regression analysis showed that age and APACHE Ⅱ score were independent risk factors for AKI in patients with traumatic hemorrhagic shock (both P＜0.001). The area under the curve (AUC) for age in predicting of AKI in patients with traumatic hemorrhagic shock was 0.656 (95% confidence interval: 0.585-0.727, P＜0.001), optimal cut-off value was 76.50 years, and the sensitivity, specificity and Youden index were 53.2%, 72.5% and 0.26, respectively. The AUC for APACHE Ⅱ score in prediction was 0.696 (95% confidence interval: 0.629-0.764, P＜0.001), optimal cut-off value was 18.50, and the sensitivity, specificity and Youden index were 60.8%, 68.1% and 0.29, respectively. Conclusions  Age and APACHE Ⅱ score are independent risk factors for AKI in patients with traumatic hemorrhagic shock. Both have certain predictive value for AKI in patients with traumatic hemorrhagic shock.