Development and Validation of a Risk Score for Prediction of Acute Kidney Injury in Patients With Acute Decompensated Heart Failure: A Prospective Cohort Study in China.
Development and Validation of a Risk Score for Prediction of Acute Kidney Injury in Patients With Acute Decompensated Heart Failure: A Prospective Cohort Study in China.
复制标题
预测急性失代偿性心力衰竭患者急性肾损伤的风险评分的制定和验证：中国的一项前瞻性队列研究
DOI：
10.1161/jaha.116.004035
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发表时间：
2016-11-16
影响因子：
5.4
通讯作者：
Chen PY
中科院分区：
文献类型：
--
作者：
Zhou LZ;Yang XB;Guan Y;Xu X;Tan MT;Hou FF;Chen PY
背景虽然已经确定了急性肾损伤（阿基）的几个危险因素，但急性失代偿性心力衰竭患者中阿基的早期检测仍然是一个挑战。本研究的目的是开发和验证急性失代偿性心力衰竭患者阿基早期预测的风险评分。方法和结果共676例连续急性失代偿性心力衰竭参与者前瞻性纳入6个区域中心医院。分析了507名参与者的数据。来自6家医院中的4家（n=321）的参与者被用于制定风险评分并进行内部验证。在来自其他2家医院的参与者（n=186）中对开发的风险评分进行了外部验证。使用序贯逻辑回归来开发和验证风险评分。使用c统计量和校准图评估拟定风险评分的区分度和校准。阿基的总体发生率为33.1%（168/507）。风险评分范围为0 - 55，表现出良好的区分能力，乐观校正的c统计量为0.859。外部验证获得了相似的结果，c统计量为0.847（95% CI 0.819 - 0.927）。风险评分具有良好的校准性，从校准图中未观察到明显的预测过高或过低。结论新的AKI风险评分是一种简单、准确的工具，可以帮助临床医生评估急性失代偿性心力衰竭患者发生阿基的风险，从而帮助他们及时计划和启动最合适的疾病管理。
Background Although several risk factors for acute kidney injury (AKI) have been identified, early detection of AKI in acute decompensated heart failure patients remains a challenge. The aim of this study was to develop and validate a risk score for early prediction of AKI in acute decompensated heart failure patients. Methods and Results A total of 676 consecutive acute decompensated heart failure participants were prospectively enrolled from 6 regional central hospitals. Data from 507 participants were analyzed. Participants from 4 of the 6 hospitals (n=321) were used to develop a risk score and conduct internal validation. External validation of the developed risk score was conducted in participants from the other 2 hospitals (n=186). Sequential logistic regression was used to develop and validate the risk score. The c statistic and calibration plot were used to assess the discrimination and calibration of the proposed risk score. The overall occurrence of AKI was 33.1% (168/507). The risk score, ranging from 0 to 55, demonstrated good discriminative power with an optimism‐corrected c statistic of 0.859. Similar results were obtained from external validation with c statistic of 0.847 (95% CI 0.819‐0.927). The risk score had good calibration with no apparent over‐ or under‐prediction observed from calibration plots. Conclusions The novel risk score is a simple and accurate tool that can help clinicians assess the risk of AKI in acute decompensated heart failure patients, which in turn helps them plan and initiate the most appropriate disease management for patients in time.