目的 探討美國克利夫蘭大學(xué)急性腎衰竭風(fēng)險(xiǎn)評(píng)分系統(tǒng)( the Clinical Score to Predict Acute Renal Failure,簡稱 Cleveland評(píng)分系統(tǒng))預(yù)測(cè)中國心臟手術(shù)患者術(shù)后發(fā)生急性腎衰竭( ARF)行腎臟替代治療( RRT)及患者院內(nèi)死亡的應(yīng)用價(jià)值。方法 將 2005年 1月至 2009年 12月期間上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院收治的所有成人心臟手術(shù)患者 2 153例納入研究,其中男 1 267例,女 886例;年齡 58.70(18~ 99)歲。術(shù)前按 Cleveland評(píng)分分值將所有患者分層:0~ 2分(n=979),3~ 5分(n=1 116),6~ 8分(n=54),9~ 13分(n=4),比較各組間術(shù)后發(fā)生 ARF行 RRT的發(fā)生率、多器官功能衰竭( MOSF)的發(fā)生率及病死率。應(yīng)用受試者工作特征( ROC)曲線評(píng)價(jià)該評(píng)分預(yù)測(cè)術(shù)后發(fā)生 ARF行 RRT、患者院內(nèi)死亡的準(zhǔn)確性。結(jié)果 0~ 2分、3~ 5分、6~ 8分、9~ 13分組術(shù)后發(fā)生 ARF行 RRT的發(fā)生率分別為 0.92%、1.88%、12.96%和 25.00%(χ2=55.635,P=0.000),MOSF發(fā)生率分別為1.23%、 1.88%、3.70%和 25.00%(χ2=16.080,P=0.001),病死率分別為 0.92%、4.21%、25.93%和 50.00%(χ2=71.470, P=0.000),4組差異均有統(tǒng)計(jì)學(xué)意義。Cleveland評(píng)分預(yù)測(cè)術(shù)后行RRT的 ROC曲線下面積( AUC)為 0.775[95% CI(0.713,0.837),P=0.000],預(yù)測(cè)院內(nèi)死亡 AUC為 0.764[95% CI(0.711,0.817),P=0.000]。結(jié)論 Cleveland評(píng)分系統(tǒng)可有效預(yù)測(cè)中國成人心臟手術(shù)后發(fā)生 ARF需 RRT治療的風(fēng)險(xiǎn),為及早對(duì)高危人群采取有效的預(yù)防措施提供依據(jù)。
引用本文: 王旭冬,車妙琳,謝波等. 美國克利夫蘭大學(xué)急性腎衰竭風(fēng)險(xiǎn)評(píng)分系統(tǒng)在我國成人心臟手術(shù)患者中的應(yīng)用. 中國胸心血管外科臨床雜志, 2012, 19(3): 262-265. doi: 復(fù)制
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1. | Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol, 2006, 1(1):19-32. |
2. | Thakar CV, Arrigain S, Worley S, et al. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol, 2005, 16(1):162-168. |
3. | Candela-Toha A, Elías-Martín E, Abraira V, et al. Predicting acute renal failure after cardiac surgery:external validation of two new clinical scores. Clin J Am Soc Nephrol, 2008, 3(5):1260-1265. |
4. | Di Bella I, Da Col U, Ciampichini R, et al. Validation of a new scoring system to predict the risk of postoperative acute renal failure in cardiac surgery. G Ital Cardiol, 2007, 8(5):306-310. |
5. | Englberger L, Suri RM, Li Z, et al. Validation of clinical scores predicting severe acute kidney injury after cardiac surgery. Am J Kidney Dis, 2010, 56(4):623-631. |
6. | 章淬, 王翔, 趙誼, 等. 美國克利夫蘭大學(xué)急性腎功能衰竭評(píng)分系統(tǒng)在中國人心臟手術(shù)圍術(shù)期的應(yīng)用. 中國胸心血管外科臨床雜志, 2010, 17(6):456-469. |
7. | Herget-Rosenthal S, Saner F, Chawla LS. Approach to hemodynamic shock and vasopressors. Clin J Am Soc Nephrol, 2008, 3(2):546-553. |
8. | Abuelo JG. Normatensive ischemic acute renal failure. N Engl J Med, 2007, 357(8):797-805. |
9. | Mehta RH, Grab JD, O’Brien SM, et al. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation, 2006, 114(21):2208-2216. |
10. | Wijeysundera DN, Karkouti K, Dupuis JY, et al. Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery. JAMA, 2007, 297(16):1801-1809. |
11. | Ricci Z, Bellomo R, Ronco C. Dose of dialysis in acute renal failure. Clin J Am Soc Nephrol, 2006, 1(3):380-388. |
12. | Liu KD, Himmelfarb J, Paganini E, et al. Timing of initiation of dialysis in critically ill patients with acute kidney injury. Clin J Am Soc Nephrol, 2006, 1(5):915-919. |
13. | Mishra J, Dent C, Tarabishi R, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet, 2005, 365(9466):1231-1238. |
14. | Siew ED, Ikizler TA, Gebretsadik T, et al. Elevated urinary IL-18 levels at the time of ICU admission predict adverse clinical outcomes. Clin J Am Soc Nephrol, 2010, 5(8):1497-1505. |
15. | Koyner JL, Vaidya VS, Bennett MR, et al. Urinary biomarkers in the clinical prognosis and early detection of acute kidney injury. Clin J Am Soc Nephrol, 2010, 5(12):2154-2165. |
16. | Haase M, Bellomo R, Devarajan P, et al. Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury:a systematic review and meta-analysis. Am J Kidney Dis, 2009, 54(6):1012-1024. |
- 1. Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol, 2006, 1(1):19-32.
- 2. Thakar CV, Arrigain S, Worley S, et al. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol, 2005, 16(1):162-168.
- 3. Candela-Toha A, Elías-Martín E, Abraira V, et al. Predicting acute renal failure after cardiac surgery:external validation of two new clinical scores. Clin J Am Soc Nephrol, 2008, 3(5):1260-1265.
- 4. Di Bella I, Da Col U, Ciampichini R, et al. Validation of a new scoring system to predict the risk of postoperative acute renal failure in cardiac surgery. G Ital Cardiol, 2007, 8(5):306-310.
- 5. Englberger L, Suri RM, Li Z, et al. Validation of clinical scores predicting severe acute kidney injury after cardiac surgery. Am J Kidney Dis, 2010, 56(4):623-631.
- 6. 章淬, 王翔, 趙誼, 等. 美國克利夫蘭大學(xué)急性腎功能衰竭評(píng)分系統(tǒng)在中國人心臟手術(shù)圍術(shù)期的應(yīng)用. 中國胸心血管外科臨床雜志, 2010, 17(6):456-469.
- 7. Herget-Rosenthal S, Saner F, Chawla LS. Approach to hemodynamic shock and vasopressors. Clin J Am Soc Nephrol, 2008, 3(2):546-553.
- 8. Abuelo JG. Normatensive ischemic acute renal failure. N Engl J Med, 2007, 357(8):797-805.
- 9. Mehta RH, Grab JD, O’Brien SM, et al. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation, 2006, 114(21):2208-2216.
- 10. Wijeysundera DN, Karkouti K, Dupuis JY, et al. Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery. JAMA, 2007, 297(16):1801-1809.
- 11. Ricci Z, Bellomo R, Ronco C. Dose of dialysis in acute renal failure. Clin J Am Soc Nephrol, 2006, 1(3):380-388.
- 12. Liu KD, Himmelfarb J, Paganini E, et al. Timing of initiation of dialysis in critically ill patients with acute kidney injury. Clin J Am Soc Nephrol, 2006, 1(5):915-919.
- 13. Mishra J, Dent C, Tarabishi R, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet, 2005, 365(9466):1231-1238.
- 14. Siew ED, Ikizler TA, Gebretsadik T, et al. Elevated urinary IL-18 levels at the time of ICU admission predict adverse clinical outcomes. Clin J Am Soc Nephrol, 2010, 5(8):1497-1505.
- 15. Koyner JL, Vaidya VS, Bennett MR, et al. Urinary biomarkers in the clinical prognosis and early detection of acute kidney injury. Clin J Am Soc Nephrol, 2010, 5(12):2154-2165.
- 16. Haase M, Bellomo R, Devarajan P, et al. Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury:a systematic review and meta-analysis. Am J Kidney Dis, 2009, 54(6):1012-1024.