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期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-077169

摘要内容如下：

客观

开发并外部验证严重顺铂相关急性肾损伤（CP-AKI）的预测模型。

设计

多中心队列研究。

设置

美国六个地理上不同的主要学术癌症中心。

参与者

2006-22年接受首剂顺铂静脉注射的成人（≥18岁）。

主要结果指标

主要转归是CP-AKI，定义为首次静脉注射顺铂后14天内血清肌酐或肾脏替代治疗增加两倍或更多。使用多变量逻辑回归模型确定CP-AKI的独立预测因素，该模型在衍生队列中开发，并在外部验证队列中进行测试。对于主模型，使用限制三次样条检验连续变量。通过将主要模型的优势比转换为风险点，还生成了一个简单的风险模型。最后，使用多变量Cox模型来检验CP-AKI的严重程度与90天生存率之间的关系。

结果

共纳入24717名成人，其中11766人为衍生队列（中位年龄59岁（四分位间距（IQR）50-67）），12951人为验证队列（中位年龄60岁（IQR 50-67））。衍生队列中CP-AKI的发生率为5.2%（608/11766），验证队列中为3.3%（421/12951）。在衍生队列中，以下每个因素均与CP-AKI独立相关：年龄、高血压、糖尿病、血清肌酐水平、血红蛋白水平、白细胞计数、血小板计数、血清白蛋白水平、血清镁水平和顺铂剂量。在推导队列和验证队列中，由9个协变量组成的简单风险评分以单调方式预测CP-AKI的较高风险。与最低风险类别的患者相比，最高风险类别的患者在衍生队列中CP-AKI的几率高24.00倍（95%置信区间（CI）13.49倍至42.78倍），在验证队列中CP-AKI的几率高17.87倍（10.56倍至29.60倍）。主要模型的C统计量为0.75，并且显示出比先前发表的模型更好的CP-AKI区分度，先前发表的模型的C统计量范围为0.60至0.68（每次比较的Delong p<0.001）。CP-AKI严重程度越高，90天生存期越短（3期CP-AKI与无CP-AKI相比，调整后的风险比为4.63（95%CI 3.56-6.02））。

结论

该研究发现，基于接受静脉注射顺铂的患者的现成变量的简单风险评分可以预测严重CP-AKI的风险，其发生与死亡密切相关。

英文原文如下：

Abstracts

OBJECTIVE  To develop and externally validate a prediction model for severe cisplatin associated acute kidney injury (CP-AKI).

DESIGN  Multicenter cohort study.

SETTING  Six geographically diverse major academic cancer centers across the US.

PARTICIPANTS  Adults (≥18 years) receiving their first dose of intravenous cisplatin, 2006-22.

MAIN OUTCOME MEASURES  The primary outcome was CP-AKI, defined as a twofold or greater increase in serum creatinine or kidney replacement therapy within 14 days of a first dose of intravenous cisplatin. Independent predictors of CP-AKI were identified using a multivariable logistic regression model, which was developed in a derivation cohort and tested in an external validation cohort. For the primary model, continuous variables were examined using restricted cubic splines. A simple risk model was also generated by converting the odds ratios from the primary model into risk points. Finally, a multivariable Cox model was used to examine the association between severity of CP-AKI and 90 day survival.

RESULTS  A total of 24 717 adults were included, with 11 766 in the derivation cohort (median age 59 (interquartile range (IQR) 50-67)) and 12 951 in the validation cohort (median age 60 (IQR 50-67)). The incidence of CP-AKI was 5.2% (608/11 766) in the derivation cohort and 3.3% (421/12 951) in the validation cohort. Each of the following factors were independently associated with CP-AKI in the derivation cohort: age, hypertension, diabetes mellitus, serum creatinine level, hemoglobin level, white blood cell count, platelet count, serum albumin level, serum magnesium level, and cisplatin dose. A simple risk score consisting of nine covariates was shown to predict a higher risk of CP-AKI in a monotonic fashion in both the derivation cohort and the validation cohort. Compared with patients in the lowest risk category, those in the highest risk category showed a 24.00-fold (95% confidence interval (CI) 13.49-fold to 42.78-fold) higher odds of CP-AKI in the derivation cohort and a 17.87-fold (10.56-fold to 29.60-fold) higher odds in the validation cohort. The primary model had a C statistic of 0.75 and showed better discrimination for CP-AKI than previously published models, the C statistics for which ranged from 0.60 to 0.68 (DeLong P<0.001 for each comparison). Greater severity of CP-AKI was monotonically associated with shorter 90 day survival (adjusted hazard ratio 4.63 (95% CI 3.56 to 6.02) for stage 3 CP-AKI versus no CP-AKI).

CONCLUSION  This study found that a simple risk score based on readily available variables from patients receiving intravenous cisplatin could predict the risk of severe CP-AKI, the occurrence of which is strongly associated with death.

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