Acute kidney injury in non-critical care setting: elaboration and validation of an in-hospital death prognosis score
Acute kidney injury in non-critical care setting: elaboration and validation of an in-hospital death prognosis score
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DOI：
10.1186/s12882-019-1610-9
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发表时间：
2019-11-21
期刊：
影响因子：
2.3
通讯作者：
Ducloux, Didier
中科院分区：
文献类型：
--
作者：
Bamoulid, Jamal;Philippot, Helene;Ducloux, Didier
背景 急性肾损伤（AKI）仍然具有高死亡率的特点。虽然大多数 AKI 患者入住传统医疗单位，但当前可用数据仍然来自针对重症监护病房 (ICU) 患者设计的研究。我们的研究旨在详细阐述和验证传统医疗机构收治的 AKI 院内死亡预后评分。方法 我们纳入了两个前瞻性队列，其中包括 2001 年至 2004 年期间（详细队列 (EC)）和 2010 年至 2014 年期间（验证队列 (VC)）入院的连续 AKI 患者。我们根据 EC 入院时记录的临床和生物学参数开发了一个评分系统，用于预测院内死亡率。然后在 VC 中测试该分数以进行验证。结果 EC 组和 VC 组分别包含 300 名患者、23 名患者和 534 名患者。院内死亡比例分别为15.5%（EC）和8.9%（VC），主要死于败血症。与 EC 院内死亡独立相关的参数是格拉斯哥评分、需氧量、液体超负荷、舒张压、多发性骨髓瘤和凝血酶原时间。 VC 验证后，院内死亡预后评分 AUC 为 0.845 +/- 0.297 (p < 0.001)。结论 我们的院内死亡预后评分是第一个针对传统医疗机构收治的 AKI 进行前瞻性开发和验证的评分。根据入院时轻松收集的当前参数，该评分可能成为医生和肾病专家确定该 AKI 人群院内死亡预后的有用工具。
Background Acute kidney injury (AKI) is still characterized by a high mortality rate. While most patients with AKI are admitted in conventional medical units, current available data are still obtained from studies designed for patients admitted in intensive care units (ICU). Our study aimed to elaborate and validate an in-hospital death prognosis score for AKI admitted in conventional medical care units. Methods We included two prospective cohorts of consecutive patients with AKI admitted between 2001 and 2004 (elaboration cohort (EC)) and between 2010 and 2014 (validation cohort (VC)). We developed a scoring system from clinical and biological parameters recorded at admission from the EC to predict in-hospital mortality. This score was then tested for validation in the VC. Results Three-hundred and twenty-three and 534 patients were included in the EC and VC cohorts, respectively. The proportion of in-hospital death were 15.5% (EC) and 8.9% (VC), mainly due to sepsis. The parameters independently associated with the in-hospital death in the EC were Glasgow score, oxygen requirement, fluid overload, blood diastolic pressure, multiple myeloma and prothrombin time. The in-hospital death prognosis score AUC was 0.845 +/- 0.297 (p < 0.001) after validation in the VC. Conclusions Our in-hospital death prognosis score is the first to be prospectively developed and validated for AKI admitted in a conventional medical care unit. Based on current parameters, easily collected at time of admission, this score could be a useful tool for physicians and nephrologists to determine the in-hospital death prognosis of this AKI population.