APACHE Ⅱ评分联合肾血管阻力指数及KIM-1对急性肾损伤患者预后的预测价值

Prognostic value of APACHE Ⅱ score combined with renal vascular resistance index and KIM-1 in patients with acute kidney injury

摘要:

目的 探讨急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分联合肾血管阻力指数（RRI）及肾损伤分子-1（KIM-1）对急性肾损伤患者预后的预测价值。方法 回顾性分析2023年1月—2024年12月南充市中心医院收治的203例急性肾损伤患者的病历资料。患者均接受连续性肾脏替代治疗（CRRT）。随访28 d，根据患者预后分为死亡组（69例）与存活组（134例）。比较死亡组与生存组的APACHE Ⅱ评分、RRI、血清KIM-1水平及临床资料。采用多因素一般Logistic回归模型分析急性肾损伤患者死亡的影响因素。绘制受试者工作特征（ROC）曲线分析APACHE Ⅱ评分、RRI、血清KIM-1及三者联合对急性肾损伤患者死亡的预测价值。结果 死亡组的APACHE Ⅱ评分、RRI和血清KIM-1水平均高于生存组（P <0.05）。死亡组的年龄大于生存组（P <0.05），病情分期Ⅲ期占比均高于生存组（P <0.05）。多因素一般Logistic回归分析结果显示，APACHE Ⅱ评分高［O^R=3.838（95% CI：2.008，7.336）］、RRI高［O^R=3.717（95% CI：1.945，7.105）］、血清KIM-1水平高［O^R=3.550（95% CI：1.858，6.785）］、病情分期Ⅲ期［O^R=3.059（95% CI：1.600，5.846）］均为急性肾损伤患者死亡的危险因素（P <0.05）。ROC曲线分析结果显示，APACHE Ⅱ评分、RRI、血清KIM-1及三者联合预测急性肾损伤患者死亡的敏感性分别为84.06%（95% CI：0.728，0.914）、84.06%（95% CI：0.728，0.914）、89.86%（95% CI：0.796，0.955）、89.86%（95% CI：0.796，0.955）；特异性分别为72.38%（95% CI：0.639，0.796）、83.58%（95% CI：0.760，0.892）、73.13%（95% CI：0.647，0.802）、93.28%（95% CI：0.873，0.967）；曲线下面积分别为0.805（95% CI：0.703，0.886）、0.847（95% CI：0.749，0.915）、0.799（95% CI：0.695，0.879）、0.913（95% CI：0.826，0.961）。结论 APACHE Ⅱ评分、RRI、血清KIM-1在评估急性肾损伤患者预后中具有重要价值，且三者联合的预测价值更高。

Abstract:

Objective To evaluate the prognostic value of the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score combined with renal vascular resistance index (RRI) and kidney injury molecule-1 (KIM-1) in predicting mortality in acute kidney injury (AKI) patients requiring continuous renal replacement therapy (CRRT).Methods Medical records of 203 AKI patients admitted between January 2023 and December 2024 and receiving CRRT were retrospectively reviewed. Patients were divided into death (n = 69) and survival (n = 134) groups based on 28-day outcome. APACHE Ⅱ score, RRI, serum KIM-1 level, and clinical data were compared. Multivariate logistic regression identified mortality risk factors. ROC analysis assessed the predictive value of APACHE Ⅱ, RRI, KIM-1, and their combination.Results APACHE Ⅱ score, RRI, and KIM-1 levels were significantly higher in the death group (P < 0.05). Age and proportion of stage Ⅲ AKI were also higher (P < 0.05). Multivariate analysis identified high APACHE Ⅱ [O^R = 3.838 (95% CI: 2.008, 7.336) ], high RRI [O^R = 3.717 (95% CI: 1.945, 7.105) ], high KIM-1 [O^R = 3.550 (95% CI: 1.858, 6.785) ], and stage Ⅲ AKI [O^R = 3.059 (95% CI: 1.600, 5.846) ] as independent risk factors for mortality (P < 0.05). ROC analysis showed sensitivities for APACHE Ⅱ, RRI, KIM-1, and their combination predicting mortality were 84.06%, 84.06%, 89.86%, and 89.86%, respectively; specificities were 72.38%, 83.58%, 73.13%, and 93.28%, respectively. AUCs were 0.805, 0.847, 0.799, and 0.913, respectively.Conclusion APACHE Ⅱ score, RRI, and serum KIM-1 are significant predictors of mortality in CRRT-treated AKI patients, with their combination demonstrating superior prognostic value.