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| 老年患者全髋关节置换术后急性肾损伤的危险因素分析及预测模型建立 |
| Risk factors analyze and establishment of predictive model of acute kidney injury in elderly patients after total hip arthroplasty |
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| DOI：10.12089/jca.2021.01.011 |
| 中文关键词: 全髋关节置换术 老年患者 急性肾损伤 危险因素 预测模型 |
| 英文关键词: Total hip arthroplasty Elderly patients Acute kidney injury Risk factors Predictive model |
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| 中文摘要: |
目的 探讨老年患者全髋关节置换术后急性肾损伤（AKI）的危险因素并建立风险预测模型。
方法 回顾性分析行全髋关节置换术老年患者633例，男243例，女390例，年龄65~96岁，ASA Ⅰ—Ⅲ级。根据改善全球肾脏病预后组织（KDIGO）指南中的诊断标准: 48 h内血清肌酐值升高≥26.5 μmol/L；血清肌酐值升高超过基础值的1.5倍及以上，且明确或经推断上述情况发生在7 d内，将患者分为AKI组（n=68）和非AKI组（n=565）。分别收集患者的人口学资料、基础疾病史、围术期一般情况及相关实验室检查。将组间差异有统计学意义的单因素纳入二元Logistic回归模型，分析老年患者全髋关节置换术后AKI的危险因素并建立风险预测模型。
结果 术后有68例（10.74%）患者发生AKI。单因素分析显示：年龄增加、高BMI、低蛋白血症、低预估肾小球滤过率（eGFR）、中重度贫血、术中低血压持续时间、出血量及血清高浓度胱抑素C与术后AKI有关（P<0.05）。二元Logistic回归分析显示：年龄增加（OR=1.120，95%CI 1.063~1.180,P<0.001）、高BMI（OR=1.283，95%CI 1.149~1.433,P<0.001）、重度贫血（OR=24.688，95%CI 3.019~201.858,P=0.003）、血清高浓度胱抑素C（OR=1.749，95%CI 1.146~2.670,P=0.010）、低蛋白血症（OR=9.386，95%CI 4.798~18.359,P<0.001）和低eGFR（OR=3.468，95%CI 1.213~9.913,P=0.020）是老年患者全髋关节置换术后AKI的独立危险因素，建立的风险预测模型受试者工作特征（ROC）曲线下面积为0.91（95%CI 0.87~0.94，P<0.001），敏感性83.80%，特异性84.40%。
结论 年龄增加、高BMI、重度贫血、血清高浓度胱抑素C、低蛋白血症和低eGFR是老年患者全髋关节置换术后AKI的独立危险因素。 |
| 英文摘要: |
Objective To explore the associated risk factors of acute kidney injury (AKI) in elderly patients after total hip arthroplasty and establish predictive model.
Methods A total of 633 elderly patients undergoing total hip arthroplasty were enrolled, 243 males and 390 females, aged 65-96 years, ASA physical status Ⅰ- Ⅲ. AKI was diagnosed according to the criteria from Kidney Diease Improving Global Outcomes (KDIGO): increase in serum creatinine by ≥ 26.5 μmol/L within 48 hours or increase in serum creatinine to ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior seven days. The demographic data, clinical history, perioperative situation, and laboratory results were collected. Risk factors of AKI in elderly patients after total hip arthroplasty were evaluated using Univariate and Multiple Logistic regression analysis, and established predictive model.
Results There were 68 (10.74%) patients developed postoperative AKI. Univariate analysis showed that the independent variables of postoperative AKI were the older age, high BMI, hypoproteinemia, decreased estimated glomerularfictration rate (eGFR), moderate to severe anemia, duration of intraoperative hypotension, bleeding volume, and high concentration of Cystatin C. The results of multi-factor Logistic regression analysis indicates that the older age (OR = 1.120, 95% CI 1.063-1.180, P < 0.001), high BMI (OR = 1.283, 95% CI 1.149-1.433, P < 0.001), severe anemia (OR = 24.688, 95% CI 3.019-201.858, P = 0.003), high concentration of Cystatin C in serum(OR = 1.749, 95% CI 1.146-2.670, P = 0.010) and hypoproteinemia (OR = 9.386,95% CI 4.798-18.359, P < 0.001) and decreased eGFR (OR = 3.468, 95% CI 1.213-9.913, P = 0.020) were independent predictors of postoperative AKI. The area under curve of receiver operating characteristic (ROC) curve was 0.91 (95% CI 0.87-0.94, P < 0.001). The predictive model had an ideal sensitivity (83.80%) and specificity (84.40%).
Conclusion Older age, high BMI, severe anemia, high concentration of Cystatin C in serum, hypoproteinemia and decreased eGFR are independent risk factors of AKI in elderly patients after total hip arthroplasty. |
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