急性心肾综合征预警评分系统在临床运用中的价值初探

摘要

目的：探讨急性心肾综合征(cardiorenal syndrome,CRS)预警评分系统在临床运用中的价值。方法回顾性分析我院2014年1月至2015年1月因急性心功能衰竭住院的353例患者的临床资料,采用两种CRS预警评分系统进行评分,评估患者发生急性肾损伤的危险度,并与实际发病率进行对比,同时比较有或无急性CRS患者住院期间的病死率。结果 Forman 等预警评分系统的评分结果中,353例患者中评分3分者181例,所占比率最高(占51.3%)；评分4分及以上者(评分最高组)发生CRS的比率最高(59例,占57.6%)；CRS实际发生率与 CRS预测发生率之间存在一定差异,但总体趋势为评分越高,CRS的发生率越高,与临床相符,即随着评分增加,CRS的实际发生率分别为0、13.33%、17.02%、47.51%、57.6%；评分最高组(评分4分及以上者)病死率最高(10例,占16.9%)。谌贻璞等预警评分系统的评分中,判定评分4~7分者为低危,而本研究353例患者中评分为低危者所占比率最高(139例,占39.4%)；评分16分及以上者发生 CRS 的比率最高(25例,占86.2%)；CRS实际发生率与CRS预测发生率之间也存在一定差异,但总体趋势仍为评分越高,CRS的发生率越高,与临床相符,即随着评分增加,CRS 的实际发生率分别为11.4%、26.6%、35.5%、68.4%、86.2%；评分最高组(评分16分及以上者)病死率最高(5例,占17.2%)。两种评分系统中CRS实际发生率与 CRS预测发生率之间均存在一定差异,但总体趋势仍为评分越高,CRS的发生率越高,与临床相符。353例患者中,共有138例发生 CRS,发生率为39.1%；死亡者27例,病死率为7.65%。发生CRS的138例患者中,死亡22例,病死率为15.9%；未发生CRS的215例患者中,死亡5例,病死率为2.3%。二者病死率比较,差异有统计学意义(P<0.05)。结论 CRS总体发生率高,两种评分系统均能有效筛选出CRS高危患者,CRS高危患者病死率较高,提示在临床实践中应及时评估急性心功能衰竭患者发生急性肾损伤的危险度,以便尽早干预治疗,降低病死率。%Objective To discuss the clinically applied value of acute cardiorenal syndrome warning scoring system.Methods A retrospective analysis was performed on clinical data of 353 pa-tients who hospitalized to Cardiology Department of our hospital from January 2014 to January 2015 due to acute heart failure.Two types of cardiorenal syndrome (CRS)early warning scoring system were used to assess the risk of acute kidney inj ury,which was compared with the actual incidence. The mortality of patients with or without CRS was compared during hospitalization period.Results In Forman and other early warning scoring systems,1 8 1 cases scored 3 points,accounting for 5 1 .3%. The incidence of CRS in the patients with 4 points or more was highest (59 cases,57.6%).Though there were some differences between the predictive CRS incidence and the actual CRS incidence,the o-verall trend was the higher the scores,the higher the incidence,which was in line with the clinical practice.With the score increased,the actual incidence of CRS was 0,13.33%,17.02%,47.51%, and 57.6%.The highest score group (score 4 points and above)got the highest mortality (10 cases, 16.9%).The early warning scoring system by Chen Yi-pu et al assessed 4-7 points (low-risk)had the highest percentage (39.4%).The patients with 16 points or more had the highest occurrence of CRS (25 cases,86.2%).Though there were some differences between the predictive CRS incidence and the actual CRS incidence,the overall trend was the higher the score,the higher the incidence,which was in line with the clinical practice.With the score increased,the actual incidence of CRS was 1 1 .4, 26.6%,35.5%,68.4%,and 86.2%.The highest score group (score 16 points and above)obtained the highest mortality (5 cases,17.2%).Although both scoring systems had some differences between the predictive CRS incidence and the actual CRS incidence,the overall trend was the higher the score, the higher the incidence,which was in line with the clinical practice.CRS occurred in 138 cases out of 353 cases (39.1%).There were 27 deaths with mortality of 7.65%.In 138 cases of CRS,there were 22 deaths with the mortality of 15.9%,and in the remaining 215 cases,there were 5 deaths with mor-tality of 2.3% (P<0.05).Conclusions The overall incidence of CRS was high,and the two scoring systems can effectively screen out high-risk patients with CRS.High-risk CRS patients showed a high-er mortality.It is suggested that in clinical practice we need to assess the risk of acute heart failure in patients with acute kidney inj ury as early as possible,so as to take early intervention to reduce mortal-ity.