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中华重症医学电子杂志 ›› 2021, Vol. 07 ›› Issue (02) : 103 -109. doi: 10.3877/cma.j.issn.2096-1537.2021.02.002

临床研究

凝血SOFA评分对严重脓毒症相关急性肾损伤患者预后的预测价值
冀晓俊1,(), 林瑾1, 王海曼1, 段美丽1   
  1. 1. 100050 首都医科大学附属北京友谊医院重症医学科
  • 收稿日期:2021-03-19 出版日期:2021-05-28
  • 通信作者: 冀晓俊

Value of baseline SOFA coagulation score for prediction of prognosis in patients with severe sptic AKI

Xiaojun Ji1(), Jin Lin1, Haiman Wang1, Meili Duan1   

  1. 1. Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
  • Received:2021-03-19 Published:2021-05-28
  • Corresponding author: Xiaojun Ji
引用本文:

冀晓俊, 林瑾, 王海曼, 段美丽. 凝血SOFA评分对严重脓毒症相关急性肾损伤患者预后的预测价值[J/OL]. 中华重症医学电子杂志, 2021, 07(02): 103-109.

Xiaojun Ji, Jin Lin, Haiman Wang, Meili Duan. Value of baseline SOFA coagulation score for prediction of prognosis in patients with severe sptic AKI[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(02): 103-109.

目的

评估基础凝血序贯器官衰竭评估(SOFA)评分对需要持续性肾替代治疗(CRRT)的严重脓毒症相关急性肾损伤(S-AKI)患者预后的预测价值。

方法

回顾性分析2017年1月至2020年10月首都医科大学附属北京友谊医院ICU收治的180例诊断为S-AKI且接受CRRT患者的临床资料,根据基础凝血SOFA评分分为凝血SOFA评分正常组(凝血SOFA评分=0)和凝血SOFA评分异常组(凝血SOFA评分≥1),主要结局指标为CRRT启动后60 d全因病死率。采用多因素Cox回归模型分析基础凝血SOFA评分及其他因素对临床预后的影响。

结果

本研究共纳入180例患者,凝血SOFA评分正常组66例,凝血SOFA评分异常组114例。凝血SOFA评分正常组60 d病死率为45.5%(30/66),凝血SOFA评分异常组60 d病死率为64.0%(73/114),2组间病死率比较差异有统计学意义(P=0.015)。2组间ICU住院时间(P=0.870)及肾替代时长(P=0.270)比较差异无统计学意义(P>0.05)。多因素Cox回归分析显示,在校正了其他因素的影响后,凝血SOFA评分异常是接受CRRT的S-AKI患者60 d死亡的独立危险因素(HR=1.616,P=0.034)。

结论

异常的凝血SOFA评分在需要CRRT的S-AKI患者中是常见的现象,开始CRRT前异常的凝血SOFA评分与60 d病死率增加显著相关。

Objective

To evaluate the prognostic value of baseline SOFA coagulation score (SOFA-CS) in patients with septic acute kidney injury (S-AKI) requiring continuous renal replacement therapy (CRRT).

Methods

This retrospective study included 180 patients with S-AKI receiving CRRT from January 2017 to October 2020 in the Department of Critical Care Medicine of Beijing Friendship Hospital affiliated to Capital Medical University. Patients were divided into normal SOFA-CS group (SOFA-CS=0) and abnormal SOFA-CS group (SOFA-CS≥1). The primary outcome was all-cause mortality at 60 days after initiation of CRRT. The association between baseline SOFA-CS, process of care, and clinical outcomes were analysed using multivariate Cox model adjusted for baseline variables.

Results

Among 180 S-AKI patients, 66 patients had normal SOFA-CS at baseline, while 114 patients had an abnormal SOFA-CS. The 60-day mortality rate in abnormal SOFA-CS group was higher than that in normal SOFA-CS group (45.5% vs 64.0%, P=0.015). There was no significant difference in the length of ICU stay (P=0.870) and duration of CRRT (P=0.270) between two groups. Multivariable Cox regression analysis showed that an abnormal SOFA-CS was independently associated with an increased risk of death at 60 days (HR=1.616, P=0.034).

Conclusion

Abnormal coagulation is a common phenomenon in patients with S-AKI receiving CRRT. An abnormal baseline SOFA coagulation score is associated with increased mortality at 60 days.

表1 凝血SOFA评分正常组和凝血SOFA评分异常组一般资料比较
一般资料 总体 凝血SOFA评分正常组(66例) 凝血SOFA评分异常组(114例) 统计值 P
年龄(岁,
x¯
±s
63.0±17.3 67.2±16.6 60.5±17.4 t=2.527 0.012
男性[例(%)] 122(67.8) 46(69.7) 76(66.7) χ2=0.176 0.740
糖尿病[例(%)] 47(26.1) 25(37.9) 22(19.3) χ2=7.480 0.008
慢性肝病[例(%)] 16(8.9) 1(1.5) 15(13.2) χ2=6.996 0.006
慢性肾病[例(%)] 36(20.0) 17(25.8) 19(16.7) χ2=2.159 0.180
APACHEⅡ评分(分,
x¯
±s
24.9±7.5 25.5±7.0 24.5±7.8 t=0.821 0.410
SOFA评分(分,
x¯
±s
10.4±3.9 8.5±3.4 11.5±3.8 t=5.339 <0.001
呼吸机应用[例(%)] 102(56.7) 34(51.5) 68(59.6) χ2=1.126 0.350
脓毒性休克[例(%)] 136(75.6) 45(68.2) 91(79.8) χ2=3.068 0.110
血Lac[mmol/L,MQ25Q75)] 2.4(1.4,5.2) 1.9(1.1,4.3) 2.6(1.6,5.4) Z=0.337 0.070
WBC(×109/L,
x¯
±s
12.7±7.8 14.3±7.9 11.8±7.6 t=2.122 0.035
Hb(g/L,
x¯
±s
94.5±27.2 97.4±29.0 92.7±26.1 t=1.117 0.270
Plt(×109/L,
x¯
±s
123.4±92.7 215.7±85.7 69.8±38.9 t=15.632 <0.001
SCr[μmol/L,MQ25Q75)] 246(155,411) 249(160,407) 244(151,420) Z=0.193 0.850
BUN(mmol/L,
x¯
±s
22.0±13.8 20.6±11.9 22.8±14.8 t=1.037 0.300
Alb(g/L,
x¯
±s
25.8±5.4 25.7±5.1 25.8±5.5 t=0.125 0.900
血钾(mmol/L,
x¯
±s
4.5±0.8 4.6±1.0 4.5±0.7 t=0.386 0.700
血糖(mmol/L,
x¯
±s
10.5±5.4 11.7±5.7 9.7±5.1 t=2.445 0.015
氧合指数(mmHg,
x¯
±s
212.1±121.7 189.4±116.9 225.6±123.2 t=1.627 0.110
碳酸氢根(mmol/L,
x¯
±s
21.1±5.7 21.2±5.5 21.1±5.8 t=0.245 0.810
PT[s,MQ25Q75)] 18(14,23) 14(13,20) 18(14,23) Z=1.332 0.180
感染部位[例(%)] χ2=0.357 0.980
肺部 105(58.3) 38(57.6) 67(58.8)
腹腔 53(29.4) 20(30.3) 33(28.9)
尿道 7(3.9) 3(4.5) 4(3.5)
血液 8(4.4) 3(4.5) 5(4.4)
其他 7(3.9) 2(3.0) 5(4.4)
表2 凝血SOFA评分正常组和凝血SOFA评分异常组预后比较
图1 凝血SOFA评分正常组和凝血SOFA评分异常组60 d Kaplan-Meier生存曲线
表3 严重S-AKI患者接受CRRT后60 d时存活组及死亡组一般资料比较
一般资料 总体 存活组(77例) 死亡组(103例) 统计值 P
年龄(岁,
x¯
±s
63.0±17.3 59.6±15.9 65.5±18.1 t=2.297 0.023
男性[例(%)] 122(67.8) 57(74.0) 65(63.1) χ2=2.405 0.150
糖尿病[例(%)] 47(26.1) 22(28.6) 25(24.3) χ2=0.422 0.610
慢性肝病[例(%)] 16(8.9) 4(5.2) 12(11.7) χ2=2.267 0.190
慢性肾病[例(%)] 36(20.0) 21(27.3) 15(14.6) χ2=4.448 0.040
APACHEⅡ评分(分,
x¯
±s
24.9±7.5 22.9±6.1 26.3±8.1 t=2.996 0.003
SOFA评分(分,
x¯
±s
10.4±3.9 9.0±3.6 11.4±3.8 t=4.405 <0.001
呼吸机应用[例(%)] 102(56.7) 36(46.8) 66(64.1) χ2=5.385 0.023
脓毒性休克[例(%)] 136(75.6) 46(59.7) 90(87.4) χ2=18.224 <0.001
血Lac[mmol/L,MQ25Q75)] 2.4(1.4,5.2) 1.8(1.1,4.1) 2.7(1.7,5.8) Z=2.268 0.003
WBC(×109/L,
x¯
±s
12.7±7.8 12.5±7.3 12.8±8.2 t=0.284 0.780
Hb(g/L,
x¯
±s
94.5±27.2 100.0±29.4 90.4±24.8 t=2.373 0.019
Plt(×109/L,
x¯
±s
123.4±92.7 150.8±102.2 102.7±78.4 t=3.556 <0.001
CRRT开始后3 d Plt下降[例(%)] 83(46.1) 32(41.5) 51(49.5) χ2=1.122 0.289
SCr[μmol/L,MQ25Q75)] 246(155,411) 264(176,446) 233(145,394) Z=1.681 0.090
BUN(mmol/L,
x¯
±s
22.0±13.8 23.0±14.7 20.8±12.6 t=1.025 0.310
Alb(g/L,
x¯
±s
25.8±5.4 26.7±4.8 25.1±5.7 t=2.032 0.044
血钾(mmol/L,
x¯
±s
4.5±0.8 4.4±0.8 4.6±0.8 t=1.894 0.060
血糖(mmol/L,
x¯
±s
10.5±5.4 10.0±4.2 10.8±6.1 t=0.984 0.330
氧合指数(mmHg,
x¯
±s
212.1±121.7 225.1±100.1 204.9±132.2 t=0.892 0.370
碳酸氢根(mmol/L,
x¯
±s
21.1±5.7 20.8±5.7 21.4±5.7 t=0.643 0.520
PT[s,MQ25Q75)] 18(14,23) 16(13,20) 18(16,25) Z=1.162 0.240
感染部位[例(%)] χ2=7.963 0.093
肺部 105(58.3) 38(49.4) 67(65)
腹腔 53(29.4) 29(37.7) 24(23.3)
尿道 7(3.9) 5(6.5) 2(1.9)
血液 8(4.4) 3(3.9) 5(4.9)
其他 7(3.9) 2(2.6) 5(4.9)
表4 严重S-AKI患者接受CRRT后60 d死亡的Cox回归分析单因素模型
表5 严重S-AKI患者接受CRRT后60 d死亡的Cox回归分析多因素模型
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