【摘要】 目的 分析万古霉素致急性肾损伤(AKI)的影响因素，并构建其风险预测列线图模型，为临床安全合理用药提供依据。方法 回顾分析2020年1月—2022年12月无锡市第二人民院217例应用万古霉素治疗的住院患者的临床资料，采用单因素和多因素Logistic回归分析筛选万古霉素致AKI的影响因素，基于影响因素构建其风险预测列线图模型。采用Bootstrap法重复抽样500次对模型进行内部验证，采用受试者工作特征(ROC)曲线评价模型区分度，采用HosmerLemeshow拟合优度检验评价模型校准度。结果 217例应用万古霉素治疗的住院患者中，发生AKI 31例(纳入AKI组)，未发生AKI 186例(纳入非AKI组)。单因素分析结果显示，两组心力衰竭、呼吸衰竭、休克、日剂量、血药浓度、联合其他抗菌药物情况、联合其他抗菌药物时间和入住重症监护病房(ICU)比较，差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示，日剂量、血药浓度、入住ICU是万古霉素致AKI的影响因素(P<0.05)。采用此3个变量构建万古霉素致AKI风险预测的列线图模型，ROC曲线下面积(AUC)为0.89，敏感度为0.87，特异度为0.78。Bootstrap法内部验证显示，验证组AUC为0.87，敏感度为0.90，特异度为0.72;Hosmer-Lemeshow拟合优度检验提示模型拟合度良好(χ~2=7.821,P=0.451)。结论 日剂量、血药浓度和入住ICU是万古霉素致AKI的影响因素，基于此构建的万古霉素致AKI风险预测列线图模型区分度和校准度均较好。更多还原

【Abstract】 Objective To analyze the influencing factors of Vancomycin-induced acute kidney injury(AKI) and to construct a risk prediction nomogram model so as to provide a basis for rational clinical drug use. Methods The clinical data of 217 inpatients treated with Vancomycin in the Second People’s Hospital of Wuxi from January 2020 to December 2022 was retrospectively analyzed. Univariate and multivariate Logistic regression analyses were used to screen the influencing factors of Vancomycininduced AKI, and then the risk prediction nomogram model was constructed based on the influencing factors. Bootstrap method was used to repeatedly sample 500 times for internal validation of the model. Receiver operating characteristic(ROC) curve was used to evaluate the discrimination of the model, and Hosmer-Lemeshow goodness of fit test was used to evaluate the calibration of the model. Results Among the 217 inpatients treated with Vancomycin, 31 patients developed AKI(included in the AKI group) and 186 patients did not develop AKI(included in the non-AKI group). Univariate analysis showed that there were statistically significant differences in heart failure, respiratory failure, shock, daily dose, blood drug concentration, combined with other antibiotics, combined time with other antibiotics and ICU stay between the two groups(P < 0.05). Multivariate Logistic regression analysis showed that daily dose, blood drug concentration and ICU stay were the influencing factors of Vancomycin-induced AKI(P < 0.05). A nomogram prediction model for vancomycin-induced AKI risk were constructed by using the three variables. The area under the curve(AUC) of ROC curve was 0.89, the sensitivity was 0.87, and the specificity was 0.78. The internal validation of Bootstrap method showed that the AUC was 0.87, the sensitivity was 0.90, and the specificity was 0.72 in the validation group. The Hosmer-Lemeshow goodness of fit test showed that the model fit was good(χ~2 = 7.821, P = 0.451). Conclusions The daily dose, blood drug concentration and ICU stay are the influencing factors of Vancomycin-induced AKI. The discrimination and calibration of the prediction model of Vancomycin-induced AKI risk nomogram are good.更多还原