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目的观察急性肾损伤(AKI)患者确诊时的血清总胆固醇(TC)水平,评价其对AKI患者90d预后的预测价值。方法采取前瞻性队列研究,入选医院获得性AKI的成年患者176例,根据诊断AKI时血清TC水平分入低TC组(<2.8mmol/L)和高TC组(≥2.8mmol/L),均随访90d,观察终点事件为死亡。结果 176例AKI患者的血清TC水平为(3.61±1.49)mmol/L,其中TC水平<2.8mmol/L低胆固醇症患者48例(27.3%)。低TC组的病死率为54.2%例(26/48),高TC组为32.8%(42/128),Kaplan-Meier生存分析显示,两组间生存曲线的差异有统计学意义(P=0.006)。Cox风险模型回归分析显示,低胆固醇血症是AKI患者90d死亡的独立危险因素之一。Logistic回归模型受试者工作特征曲线的曲线下面积为0.588(95%CI为0.489～0.687)。结论血清TC水平可以预测医院获得性AKI患者的90d死亡。
Objective To observe the level of serum total cholesterol (TC) in patients with acute kidney injury (AKI) at the time of diagnosis and evaluate their predictive value for the prognosis of patients with AKI at 90 days. Methods In a prospective cohort study, 176 adult patients with hospital-acquired AKI were divided into low TC group (<2.8mmol / L) and high TC group (≥2.8mmol / L) according to the level of serum TC in diagnosis of AKI After 90 days of follow-up, the end point was observed as death. Results The serum TC level of 176 patients with AKI was (3.61 ± 1.49) mmol / L, of which 48 patients (27.3%) had TC level <2.8mmol / L and hypocholesterolemia. The mortality was 54.2% (26/48) in the low TC group and 32.8% (42/128) in the high TC group. The Kaplan-Meier survival analysis showed that there was significant difference in survival curves between the two groups (P = 0.006 ). Cox risk model regression analysis showed that hypocholesterolemia is one of the independent risk factors for 90-day death in patients with AKI. Logistic regression model subjects under the curve of the area under the curve was 0.588 (95% CI 0.489 ~ 0.687). Conclusion The level of serum TC can predict the 90-day mortality in hospital-acquired AKI patients.