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RIFLE、AKIN和KDIGO标准预测肝移植术后早期死亡的准确性比较

刘洵 薛梅 吴安石

刘洵, 薛梅, 吴安石. RIFLE、AKIN和KDIGO标准预测肝移植术后早期死亡的准确性比较[J]. 器官移植, 2020, 11(3): 369-373,390. doi: 10.3969/j.issn.1674-7445.2020.03.008
引用本文: 刘洵, 薛梅, 吴安石. RIFLE、AKIN和KDIGO标准预测肝移植术后早期死亡的准确性比较[J]. 器官移植, 2020, 11(3): 369-373,390. doi: 10.3969/j.issn.1674-7445.2020.03.008
Liu Xun, Xue Mei, Wu Anshi. Comparison of the accuracy of RIFLE, AKIN and KDIGO criteria in predicting early death after liver transplantation[J]. ORGAN TRANSPLANTATION, 2020, 11(3): 369-373,390. doi: 10.3969/j.issn.1674-7445.2020.03.008
Citation: Liu Xun, Xue Mei, Wu Anshi. Comparison of the accuracy of RIFLE, AKIN and KDIGO criteria in predicting early death after liver transplantation[J]. ORGAN TRANSPLANTATION, 2020, 11(3): 369-373,390. doi: 10.3969/j.issn.1674-7445.2020.03.008

RIFLE、AKIN和KDIGO标准预测肝移植术后早期死亡的准确性比较

doi: 10.3969/j.issn.1674-7445.2020.03.008
基金项目: 

北京市医管局重点医学专业培育项目“扬帆计划” ZYLX201822

详细信息
    作者简介:

    刘洵,女,1978年生,硕士,主治医师,研究方向为临床麻醉、肝移植麻醉,Email:sylviaxun78@163.com

    通讯作者:

    吴安石,男,1965年生,博士,博士研究生导师,主任医师,研究方向为器官移植和心胸外科麻醉与器官保护,Email:wuanshi88@163.com

  • 中图分类号: R617

Comparison of the accuracy of RIFLE, AKIN and KDIGO criteria in predicting early death after liver transplantation

More Information
  • 摘要:   目的  比较RIFLE、急性肾损伤网络(AKIN)和改善全球肾脏病预后组织(KDIGO)3个急性肾损伤(AKI)标准对肝移植受者术后早期(术后30 d)死亡的预测准确性。  方法  回顾性分析173例肝移植受者临床资料。根据RIFLE、AKIN和KDIGO 3个标准计算术后AKI发生率,分析术后30 d全因病死率及死因,应用二元Logistic回归分析术后30 d内死亡的危险因素,应用受试者工作特征(ROC)曲线比较3个标准对术后30 d内死亡的预测准确性。  结果  根据RIFLE、AKIN和KDIGO标准,术后AKI发生率分别为48.0%、51.4%和53.8%,术后30 d内死亡13例,病死率为7.5%。RIFLE、AKIN和KDIGO分期是术后30 d内死亡的独立危险因素(均为P < 0.05)。RIFLE、AKIN和KDIGO分期预测肝移植术后30 d内死亡的曲线下面积(AUC)分别为0.828、0.766和0.844,AKIN与KDIGO比较,差异有统计学意义(P < 0.05)。  结论  KDIGO标准对于肝移植受者术后早期死亡的预测能力更好。但作为工具,三者之间的比较选择尚需多中心大样本的证据支持。

     

  • 图  1  RIFLE、AKIN和KDIGO分期预测肝移植术后30 d内死亡的ROC曲线

    Figure  1.  ROC curves of RIFLE, AKIN and KDIGO staging for predicting death in 30 d after liver transplantation

    表  1  RIFLE, AKIN和KDIGO关于AKI的诊断和分期标准

    Table  1.   Diagnostic and staging criteria of AKI by RIFLE, AKIN, and KDIGO

    项目 诊断标准 分期标准
    Risk或Ⅰ期 Injury或Ⅱ期 Failure或Ⅲ期
    RIFLE
    标准
    7 d内Scr上升至≥1.5倍基线值 7 d内Scr上升至1.5倍基线值或GFR下降 > 25% 7 d内Scr上升至2倍基线值或GFR下降 > 50% 7 d内Scr上升至3倍基线值或Scr > 354 μmol/L伴急增44 μmol/L或GFR下降 > 75%
    AKIN
    标准
    48 h内Scr升高≥27 μmol/L或48 h内Scr上升至1.5倍基线值 48 h内Scr升高≥27 μmol/L或48 h内Scr上升至1.5~1.9倍基线值 48 h内Scr上升至2~3倍基线值 48 h内Scr上升至 > 3倍基线值或Scr≥354 μmol/L伴急增44 μmol/L或需肾脏替代治疗
    KDIGO
    标准
    48 h内Scr升高≥27 μmol/L或7 d内Scr上升至≥1.5倍基线值 48 h内Scr升高≥27 μmol/L或7 d内Scr上升至1.5~1.9倍基线值 7 d内Scr上升至2~3倍基线值 7 d内Scr上升至 > 3倍基线值或Scr≥354 μmol/L或需肾脏替代治疗
    注:①Scr为血清肌酐。
    ②GFR为肾小球滤过率。
    下载: 导出CSV

    表  2  肝移植术后30 d内死亡危险因素的多因素分析

    Table  2.   Multivariate analysis of risk factors for death in 30 d after liver transplantation

    变量 OR 95%CI P
    RIFLE分期 4.514 1.945~10.473 0.000
    AKIN分期 3.770 1.558~9.122 0.003
    KDIGO分期 5.343 2.071~13.788 0.001
    注:①OR为比值比。
    CI为可信区间。
    下载: 导出CSV

    表  3  RIFLE、AKIN和KDIGO分期预测肝移植术后30 d内死亡的效能

    Table  3.   Effcacy of RIFLE, AKIN and KDIGO staging for predicting death in 30 d after liver transplantation

    变量 AUC (95%CI) 灵敏度 特异度
    RIFLE分期 0.828 (0.763~0.881) 0.846 0.813
    AKIN分期 0.766 (0.696~0.827) 0.923 0.519
    KDIGO分期 0.844 (0.781~0.894)a 0.769 0.825
    注:①CI为可信区间。
    ②与AKIN分期比较,aP < 0.05。
    下载: 导出CSV
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  • 收稿日期:  2020-01-13
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2020-05-15

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