摘要
目的:分析急性心力衰竭(AHF)患者应用大剂量呋塞米持续静脉泵入所致急性肾损伤(AKI)的风险因素及构建相应预测模型。方法:回顾性选取2020年1月~2022年5月期间本院急诊科收治的100例符合标准的AHF患者作为研究对象,根据治疗期间是否发生AKI分为合并AKI组(n=37)及未合并AKI组(n=63)。组间临床资料进行单因素及多因素Logistic回归分析,得出发生AKI的风险因素;根据相关系数构建预测模型,并选用受试者工作特征(ROC)曲线评估预测模型的效能。结果:单因素分析结果提示,年龄、高血压史、吸烟史、尿素氮、血清肌酐、红细胞计数、白蛋白、血红蛋白和N-末端脑钠肽前体(NT-proBNP)均是AHF患者应用大剂量呋塞米持续静脉泵入所致AKI发生的风险因素(P<0.05)。多因素Logistic回归分析结果提示,高龄(OR=1.115,95%CI=1.019~1.220,P=0.021)、高尿素氮水平(OR=1.384,95%CI=1.107~1.731,P<0.001)和高NT-proBNP(OR=1.005,95%CI=1.001~1.009,P=0.009)均是AHF患者应用大剂量呋塞米持续静脉泵入所致AKI发生的独立危险因素;高白蛋白水平(OR=0.550,95%CI=0.370~0.819,P<0.001)是AHF患者应用大剂量呋塞米持续静脉泵入所致AKI发生的独立保护因素。ROC曲线分析结果显示,预测模型的ROC曲线下面积为0.872(95%CI=0.805~0.939,P<0.001),最大约登指数为0.639,对应的灵敏度为0.937,特异度为0.703。结论:高龄、高尿素氮水平和高NT-proBNP水平均是AHF患者应用大剂量呋塞米持续静脉泵入所致AKI发生的独立危险因素,高白蛋白水平为独立保护因素。此外,根据上述风险因素构建的预测模型,其预测效能良好,对临床评估AKI风险具有一定的借鉴意义。
Objective:To analyze the risk factors of acute kidney injury(AKI)caused by continuous intravenous infusion of high-dose furosemide in patients with acute heart failure(AHF),and to construct a corresponding predictive model.Methods:A total of 100 eligible patients with AHF who visited the emergency department of our hospital from January 2020 to May 2022 were retrospectively selected as the subjects.The enrolled patients were divided into AKI group(n=37)and non-AKI group(n=63)according to occurrence of AKI during continuous intravenous infusion of high-dose furosemide.The clinical data between groups were analyzed by univariate and multivariate logistic regression analyses to determine the risk factors of AKI and build a prediction model based on the correlation coefficient.The receiver operating characteristics(ROC)curve was used to evaluate the performance of the prediction model.Results:Univariate analysis showed that age,history of hypertension,smoking history,blood urea nitrogen,serum creatinine,red blood cell count,albumin,hemoglobin and N-terminal pro-brain natriuretic peptide(NT-proBNP)were risk factors for AKI caused by continuous intravenous infusion of high-dose furosemide in patients with AHF(P<0.05).The results of multivariate logistic regression analysis demonstrated that advanced age(OR=1.115,95%CI=1.019~1.220,P=0.021),high blood urea nitrogen level(OR=1.384,95%CI=1.107~1.731,P<0.001)and high NT-proBNP level(OR=1.005,95%CI=1.001~1.009,P=0.009)were independent risk factors for the incidence of AKI during continuous intravenous infusion of high-dose furosemide in patients with AHF.In addition,high albumin level(OR=0.550,95%CI=0.370~0.819,P<0.001)was the independent protective factor for the incidence of AKI during continuou sintravenous infusion of high-dose furosemide in patients with AHF.The results of ROC curve analysis showed that the area under the ROC curve of the prediction model was 0.872(95%CI=0.805~0.939,P<0.001),the maximum Youden index was 0.639,the corresponding sensitivity was 0.937,and the specificity was 0.703.Conclusion:Advanced age,high blood urea nitrogen level and high NT-proBNP level are independent risk factors for AKI caused by continuous intravenous infusion of high-dose furosemide in patients with AHF,and high albumin level is an independent protective factor.In addition,the predictive model constructed with the factors has good predictive performance,and has certain reference significance for the clinical risk assessment of AKI.
作者
王大伟
王宝玉
马爱华
郅红蕾
潘晓力
刘畅
吴海燕
WANG Da-wei;WANG Bao-yu;MA Aihua;ZHI Hong-lei;PAN Xiao-li;LIU Chang;WU Hai-yan(Emergency Department,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450001,China)
出处
《中国合理用药探索》
2023年第4期99-106,共8页
Chinese Journal of Rational Drug Use
基金
河南省医学科技攻关计划项目(2018020796)。
关键词
急性心力衰竭
急性肾损伤
大剂量
呋塞米
持续静脉泵入
风险因素
预测模型
acute heart failure
acute kidney injury
high dose
furosemide
continuous intravenous infusion
risk factors
predictive models
作者简介
王大伟,男,副主任医师,专业方向:急诊内科。E-mail:wangdawei67516@163.com;通讯作者:吴海燕,女,主任医师,专业方向:急诊重症。E-mail:qwphzy@163.com。
