危重病患者IAP升高与AKI发生率增加相关：来自MIMIC-IV数据库的队列研究-动脉网

Elevated IAP in critically ill patients associated with increased AKI incidence: a cohort study from the MIMIC-IV database

Nature 等信源发布 2025-03-10 20:19



可切换为仅中文







Abstract

摘要

Elevated intra-abdominal pressure can engender a spectrum of adverse physiological repercussions in patients, but further research is needed to ascertain whether elevated intra-abdominal pressure exerts significant effects on renal function. The study used MIMIC-IV database to identify critical patients with IAP monitoring.

腹腔内压力升高可能会在患者中引发一系列不良的生理反应，但还需要进一步的研究来确定腹腔内压力升高是否对肾功能产生显著影响。该研究使用MIMIC-IV数据库来识别进行IAP监测的重症患者。

Patients were categorized into Low-IAP and High-IAP groups based on the results of the restricted cubic splines curve, with HR = 1 set at IAP = 16 mmHg. The primary outcome of the study was the occurrence of AKI within 72 h of ICU admission, and secondary outcomes including the rate of CRRT utilization and 28-day all-cause mortality.

根据限制性立方样条曲线的结果，患者被分为低IAP组和高IAP组，以IAP = 16 mmHg时HR = 1为界限。研究的主要结局是ICU入院72小时内发生AKI，次要结局包括CRRT使用率和28天全因死亡率。

Cox proportional hazards regression analysis was employed to clarify the relationship between IAP and AKI. A total of 1746 patients were included in our study. Restricted cubic spline analysis demonstrated an increased risk of AKI with higher IAP. Multivariable Cox proportional hazards analysis uncovered a notable correlation between elevated IAP and AKI incidence (HR: 1.40(1.14–1.71)).

采用Cox比例风险回归分析来阐明IAP与AKI之间的关系。本研究共纳入1746名患者。限制性立方样条分析显示，IAP越高，AKI的风险越大。多变量Cox比例风险分析揭示了IAP升高与AKI发生率之间存在显著相关性（HR：1.40（1.14–1.71））。

After adjusting for confounding factors, patients with elevated IAP remained significantly related with AKI (HR: 1.23(1.01–1.52)). The Kaplan–Meier survival curves indicated a significant superior 28-day survival rate for Low-IAP group (the log-rank test p-value was 0.001) and the cumulative risk curve showed a higher demand for CRRT in the High-IAP group (the log-rank test p-value was 0.0028).

调整混杂因素后，IAP升高的患者仍与AKI显著相关（HR：1.23（1.01-1.52））。Kaplan-Meier生存曲线显示，低IAP组的28天生存率显著更高（log-rank检验p值为0.001），累计风险曲线表明高IAP组对CRRT的需求更高（log-rank检验p值为0.0028）。

Augmented intra-abdominal pressure (above 16 mmHg) is significantly associated with a higher incidence of acute kidney injury (AKI) in critically ill patients, along with an increased need for continuous renal replacement therapy (CRRT) and a higher 28-day mortality rate..

腹腔内压力增高（高于16毫米汞柱）与危重患者急性肾损伤（AKI）发生率升高显著相关，同时连续性肾脏替代治疗（CRRT）的需求增加，并且28天死亡率更高。

Introduction

简介

Elevated intra-abdominal pressure (IAH) is a common yet serious concern in critically ill patients within intensive care units (ICUs)

腹腔内压力升高（IAH）是重症监护病房（ICU）中危重病人常见但严重的问题。

. A significant global study involving 491 patients across 15 ICUs revealed that 34% of patients had IAH at admission, and nearly half developed IAH during their ICU stay

一项涉及15个ICU的491名患者的全球重要研究显示，34%的患者在入院时患有IAH，近一半的患者在ICU住院期间发展为IAH。

. According to the current consensus from the World Society of the Abdominal Compartment Syndrome (WSACS), IAH is defined as an intra-abdominal pressure exceeding 12 mmHg

根据世界腹腔间隔室综合征协会（WSACS）的当前共识，IAH被定义为腹内压超过12毫米汞柱。

. A pressure above 20 mmHg is indicative of abdominal compartment syndrome (ACS), the most severe circumstance of IAH

. 超过20毫米汞柱的压力提示腹腔间隔室综合征（ACS），这是IAH最严重的情况。

. There is a substantial link between IAH and mortality, often leading to multiple organ dysfunction

IAH 与死亡率之间存在显著关联，常导致多器官功能障碍

，

. Therefore, diligent monitoring of intra-abdominal pressure and associated organ dysfunction is crucial for managing high-risk patients effectively. This approach is essential for improving outcomes and mitigating the adverse effects of IAH and ACS in the ICU setting.

因此，密切监测腹腔内压力及相关的器官功能障碍对于有效管理高危患者至关重要。这种方法对于改善预后和减轻重症监护病房（ICU）中腹腔内高压（IAH）和腹腔间隔室综合征（ACS）的不良影响至关重要。

The kidney, particularly susceptible to heightened intra-abdominal pressure, endures compromised function as elevated pressure escalates renal venous pressure and diminishes perfusion pressure. This cascade effects a reduction in glomerular filtration rate, manifesting as oliguria and tubular dysfunction.

肾脏，尤其容易受到腹内压升高的影响，其功能会因压力升高而导致肾静脉压力增加和灌注压降低而受损。这一连串反应导致肾小球滤过率下降，表现为少尿和肾小管功能障碍。

，

. Therefore, acute kidney injury, as a prevalent condition within the ICU, may be one of the significant complications caused by elevated intra-abdominal pressure.

因此，急性肾损伤作为ICU内常见的状况，可能是由腹腔内压力升高引起的重要并发症之一。

Despite this, research exploring the link between intra-abdominal pressure and AKI remains scant, predominantly featuring observational studies with limited sample sizes

尽管如此，探索腹腔内压力与急性肾损伤之间联系的研究仍然很少，主要以样本量有限的观察性研究为主。

，

. Notably, a recent prospective cohort study among critically ill obstetric patients failed to establish a significant correlation between early AKI and intra-abdominal pressure

值得注意的是，最近在危重产科患者中进行的一项前瞻性队列研究未能建立早期AKI与腹内压之间的显著相关性。

, casting doubt on the assumed connection. This study aims to explore the relationship between intra-abdominal pressure and the occurrence of AKI.

，对假设的联系表示怀疑。本研究旨在探讨腹腔内压力与AKI发生之间的关系。

Methods

方法

Data source

数据源

The study utilized data obtained from the Medical Information Mart for Intensive Care database (MIMIC-IV 2.2,

该研究利用了从重症监护医疗信息集市数据库（MIMIC-IV 2.2）获取的数据，

https://physionet.org/content/mimiciv/2.2/

), a publicly accessible repository housing clinical data from 73,181 adult patients admitted to intensive care units (ICUs) at the Beth Israel Deaconess Medical Center in Boston, Massachusetts, USA, spanning the years 2008 to 2019

)，一个公开可访问的存储库，包含来自美国马萨诸塞州波士顿贝斯以色列女执事医疗中心重症监护室（ICU）的73,181名成年患者的临床数据，时间跨度为2008年至2019年。

. Approval for database access was granted by the Institutional Review Boards of MIT and Beth Israel Deaconess Medical Center. Given the anonymized nature of the database and its standardized data, this study was exempt from separate ethics approval in accordance with the principles outlined in the Declaration of Helsinki regarding patient populations..

数据库访问权限已由麻省理工学院和贝斯以色列女执事医疗中心的机构审查委员会批准。鉴于该数据库的匿名性质及其标准化数据，根据《赫尔辛基宣言》中关于患者群体的原则，本研究免于单独的伦理审批。

Study population

研究人群

As showed in Fig.

如图所示。

, Patients in the MIMIC-IV who received the monitoring of bladder pressure were eligible for inclusion. Subsequently, we employed the boxplot function to generate a 3σ plot, facilitating the removal of outlier measurements. Following this, we utilized the boxplot function to construct a 3σ plot, facilitating the exclusion of abnormal measurement values exceeding three standard deviations, which were excluded and subsequently imputed.

MIMIC-IV中接受膀胱压力监测的患者符合纳入条件。随后，我们使用箱线图功能生成了3σ图，以便去除异常测量值。接着，我们利用箱线图功能构建了3σ图，以排除超出三个标准差的异常测量值，这些值被剔除后进行了后续插补。

Moreover, we exclusively considered data from the initial ICU admission of each patient, and individuals who did not undergo monitoring within the first 24 h of ICU admission were also omitted from our study. Following the screening process above, the remaining patients had an ICU length of stay exceeding 24 h, and all individuals were over 18 years of age.

此外，我们仅考虑了每位患者首次入住ICU的数据，并且在ICU入院最初24小时内未接受监测的个体也被排除在研究之外。经过上述筛选过程后，剩余患者的ICU住院时间均超过24小时，所有个体年龄均大于18岁。

Finally, we computed the average bladder pressure measured within the first day of ICU admission for each patient. We divided patients into two groups based on the threshold determined by the inflection point identified through restricted cubic spline (RCS) analysis (16 mmHg)..

最后，我们计算了每位患者在ICU入院第一天内测得的膀胱压力平均值。我们根据通过限制性立方样条（RCS）分析确定的拐点（16毫米汞柱）所设定的阈值，将患者分为两组。

Fig. 1

图1

Flow chart of patient selection. MIMIC, the Medical Information Mart for Intensive Care database; ICU, Intensive care unit; IAP, Intra-abdominal pressure.

患者选择流程图。MIMIC，重症监护医疗信息数据库；ICU，重症监护室；IAP，腹内压。

Full size image

全尺寸图像

Variables and outcome

变量与结果

We utilized structured query language (SQL) to extract patients’ baseline characteristics with particular consideration given to factors already confirmed to increase the risk of AKI occurrence

我们使用结构化查询语言 (SQL) 提取患者的基线特征，特别考虑了已确认会增加急性肾损伤 (AKI) 发生风险的因素。

，

, including demographic information such as age, gender, and weight. Disease severity scores comprised the SOFA score, SAPS II score, and CCI score. Comorbidities included chronic heart failure, chronic kidney disease and diabetes. And we documented the prevalence of sepsis. The use of life support treatment on the first day was assessed, including invasive mechanical ventilation (MV) and vasopressor administration.

，包括年龄、性别和体重等人口统计学信息。疾病严重程度评分包括SOFA评分、SAPS II评分和CCI评分。合并症包括慢性心力衰竭、慢性肾病和糖尿病。我们记录了脓毒症的患病率。评估了第一天生命支持治疗的使用情况，包括有创机械通气（MV）和升压药的使用。

Additionally, laboratory parameters such as hemoglobin levels, white blood cell counts and serum creatinine were included in the analysis. All baseline indicators were extracted as the average values within the first 24 h of ICU admission. The missing values for all variables did not exceed 7%, and were imputed using the “Mice” package in R software with random forest imputation method.

此外，分析中还包括血红蛋白水平、白细胞计数和血清肌酐等实验室参数。所有基线指标均提取为ICU入院后前24小时内的平均值。所有变量的缺失值不超过7%，并使用R软件中的“Mice”包通过随机森林填补方法进行填补。

。

The primary outcome was whether patients were diagnosed with acute kidney injury (AKI) within 72 h of ICU admission, based on the criteria of Kidney Disease: Improving Global Outcomes (KDIGO)

主要结局是根据《改善全球肾脏病预后组织》(KDIGO) 的标准，患者在 ICU 入院后 72 小时内是否被诊断为急性肾损伤 (AKI)。

. AKI is defined by either an absolute increase in Scr exceeding 0.3 mg/dL (26.5 μmol/L) or a relative increase by more than 50% from baseline within 48 h, and it also can be diagnosed when urine output is less than 0.5 mL/kg/h (in adults) for 6 h or longer.

AKI定义为在48小时内，Scr绝对值增加超过0.3 mg/dL（26.5 μmol/L），或相对于基线增加超过50%；当尿量少于0.5 mL/kg/h（成人）持续6小时或更长时间时，也可诊断为AKI。

Secondary outcomes comprised the 28-day mortality rate, occurrence of AKI within one week, utilization of CRRT within 72 h and one-week.

次要结局包括28天死亡率、一周内发生AKI的情况、72小时内及一周内CRRT的使用情况。

Statistical analysis

统计分析

Continuous variables are expressed as means (standard deviations), while categorical variables are presented as total counts and percentages. Group comparisons were conducted using the X2 test or Fisher’s exact test for categorical variables, and Student’s t-test or the Mann–Whitney U test for continuous variables, as deemed appropriate..

连续变量以均值（标准差）表示，而分类变量则以总数和百分比表示。组间比较采用卡方检验或Fisher精确检验用于分类变量，而连续变量则使用Student t检验或Mann-Whitney U检验，视情况选择合适的方法。

We constructed Cox proportional hazards regression models to assess the relationship between IAP and AKI occurrence, with HR (95% CI) as the outcome measure

我们构建了Cox比例风险回归模型来评估IAP与AKI发生之间的关系，以HR（95% CI）作为结果指标。

. Certain models were adjusted for specific variables. Both clinical and prognostic variables were included in the multivariable models: Crude model: Unadjusted; Adjusted model 1: Adjusted for demographic variables including age, gender, and weight; Adjusted model 2: Adjusted for all variables, including age, gender, weight, ICU type, SOFA score, SAPSII score, Charlson Comorbidity Index (CCI), chronic heart failure (CHF), diabetes, chronic kidney disease (CKD), sepsis, vasopressor use, invasive mechanical ventilation (MV), white blood cell (WBC) count, red blood cell (RBC) count and creatinine(Cr)..

某些模型针对特定变量进行了调整。多变量模型中同时包含了临床和预后变量：原始模型：未调整；调整模型1：针对包括年龄、性别和体重在内的人口统计学变量进行调整；调整模型2：针对所有变量进行调整，包括年龄、性别、体重、ICU类型、SOFA评分、SAPSII评分、查尔森合并症指数（CCI）、慢性心力衰竭（CHF）、糖尿病、慢性肾病（CKD）、脓毒症、血管加压素使用、有创机械通气（MV）、白细胞（WBC）计数、红细胞（RBC）计数和肌酐（Cr）。

The cumulative risk curves depict the incidence of AKI within 72 h and the utilization of CRRT within 72 h for both the Low-IAP and High-IAP groups. Kaplan–Meier curves illustrate the 28-day mortality rates for patients in both groups. Subgroup analyses were conducted by stratifying the study population based on age, gender, ICU type, SOFA score, chronic heart failure (CHF), chronic kidney disease (CKD), diabetes, sepsis, use of invasive mechanical ventilation, and vasopressor therapy..

累积风险曲线描绘了低IAP组和高IAP组在72小时内发生AKI的发病率以及72小时内CRRT的使用情况。Kaplan-Meier曲线展示了两组患者的28天死亡率。通过根据年龄、性别、ICU类型、SOFA评分、慢性心力衰竭（CHF）、慢性肾病（CKD）、糖尿病、脓毒症、有创机械通气的使用以及血管加压治疗对研究人群进行分层，进行了亚组分析。

Statistical analyses were conducted using the R programming language (version 4.3.3). Statistical significance was defined as p < 0.05.

统计分析使用 R 编程语言（版本 4.3.3）进行。统计显著性定义为 p < 0.05。

Result

结果

Cohort characteristic

队列特征

A total of 1746 patients underwent intra-abdominal pressure (IAP) monitoring in the MIMIC-IV database. Ultimately, 821 patients met the inclusion criteria, with 317 patients categorized in the Low-IAP group and 504 patients in the High-IAP group. Compared to the Low-IAP group, the High-IAP group had a greater proportion of males (58.0% vs 66.1%, p = 0.025), higher body weight (83.04 vs 87.85, p < 0.001) and SOFA scores (9.0 vs 10.0, p < 0.001) (Table .

在MIMIC-IV数据库中，共有1746名患者接受了腹内压（IAP）监测。最终，821名患者符合纳入标准，其中317名患者被归类为低IAP组，504名患者被归类为高IAP组。与低IAP组相比，高IAP组男性比例更高（58.0% vs 66.1%，p = 0.025），体重（83.04 vs 87.85，p < 0.001）和SOFA评分（9.0 vs 10.0，p < 0.001）也更高（表。

）。

Table 1 Baseline characteristics and outcomes of the low- and high-IAP groups.

表1 低IAP组和高IAP组的基线特征及结果。

Full size table

全尺寸表格

Primary outcome

主要结局指标

As depicted in Fig.

如图所示。

a, the restricted cubic splines (RCS) regression model was employed to illustrate that the risk of AKI increased non-linearly with rising IAP (P for non-linearity = 0.002), selecting IAP 16 mmHg as the reference level, represented by a vertical dashed line, the horizontal dashed line indicates a hazard ratio of 1.0.

采用限制性立方样条（RCS）回归模型显示，AKI风险随着IAP升高呈非线性增加（非线性P值=0.002），选择IAP 16 mmHg作为参考水平，用垂直虚线表示，水平虚线表示危险比为1.0。

Before IAP reaches 16 mmHg, it acts as a protective factor against AKI occurrence. However, as it continues to increase, this protective effect gradually diminishes. After reaching 16 mmHg, further increases in IAP elevate the risk of AKI occurrence. Subsequently, the curve gradually enters a plateau phase, indicating that with further elevation of intra-abdominal pressure, the risk of AKI occurrence is only a minimal increase..

在腹内压 (IAP) 达到 16 mmHg 之前，它对急性肾损伤 (AKI) 的发生起到保护作用。然而，随着其继续升高，这种保护作用逐渐减弱。当 IAP 超过 16 mmHg 后，其进一步升高会增加 AKI 发生的风险。随后，曲线逐渐进入平台期，表明随着腹内压的进一步升高，AKI 发生的风险仅有轻微增加。

Fig. 2

图2

(

) Restricted cubic spline for AKI within the first 72 h of ICU admission. HR, hazard ratio; AKI, Acute kidney injury; IAP, Intra-abdominal pressure; (

) ICU入院后72小时内AKI的限制性立方样条。HR，风险比；AKI，急性肾损伤；IAP，腹内压；(

) the cumulative risk curve for AKI within the first 72 h of ICU admission. AKI, Acute kidney injury.

) ICU入院后72小时内的AKI累积风险曲线。AKI，急性肾损伤。

Full size image

全尺寸图像

Nevertheless, the area under the curve (AUC) for IAP did not meet the desired threshold of adequacy (AUC for occurrence of AKI within 72 h: 0.550, 95% CI: 0.53–0.61, p = 0.007), and we identified the optimal threshold to be 14.5 mmHg using the Youden index method.

尽管如此，IAP的曲线下面积（AUC）未达到预期的充分性阈值（72小时内发生AKI的AUC：0.550，95% CI：0.53–0.61，p = 0.007），我们通过Youden指数法确定了最佳阈值为14.5 mmHg。

Cumulative risk curves for AKI occurrence within 72 h of ICU admission were plotted using a threshold of IAP 16 mmHg, based on the inflection point identified by the Restricted Cubic Spline curve. It was observed that the high-IAP group exhibited a significantly higher risk of early AKI occurrence following ICU admission compared to the low-IAP group (log-rank P = 0.0011).

根据限制性立方样条曲线确定的拐点，使用腹内压 (IAP) 16 mmHg 的阈值绘制了 ICU 入院后 72 小时内发生急性肾损伤 (AKI) 的累积风险曲线。观察到高 IAP 组在 ICU 入院后早期发生 AKI 的风险显著高于低 IAP 组（对数秩检验 P = 0.0011）。

Subsequently, the trend in both groups gradually plateaued (Fig. .

随后，两组的趋势逐渐趋于平稳（图.

b).

The multivariate Cox regression analyses revealed a significant detrimental effect of elevated IAP on AKI occurrence (Table

多元Cox回归分析显示，IAP升高对AKI发生有显著的有害影响（表

). No adjustments were made for any confounding factors in crude model (HR: 1.40(1.14–1.71), p = 0.001). In Adjusted model 1, adjustments were made for demographic parameters (HR: 1.27(1.04–1.6), p = 0.021), while in model 2, adjustments were made for all potential influencing factors (HR: 1.23 (1.01–1.52), p = 0.039)..

). 未调整任何混杂因素的原始模型（HR：1.40（1.14-1.71），p=0.001）。在调整模型1中，对人口统计学参数进行了调整（HR：1.27（1.04-1.6），p=0.021）；而在模型2中，对所有潜在影响因素进行了调整（HR：1.23（1.01-1.52），p=0.039）。

Table 2 Cox proportional hazard ratios (HR) for AKI occurrence.

表2：AKI发生的风险比例（HR），Cox比例风险模型。

Full size table

全尺寸表格

Secondary outcomes

次要结局指标

Researchers plotted cumulative risk curves to assess the utilization of continuous renal replacement therapy (CRRT) within 72 h of ICU admission for both groups, corresponding to the occurrence of AKI (Fig.

研究人员绘制了累积风险曲线，以评估两组患者在入住ICU后72小时内连续性肾脏替代治疗（CRRT）的使用情况，对应于急性肾损伤（AKI）的发生（图。

a). The results revealed a higher demand for CRRT treatment in the high-IAP group (p = 0.0028). Additionally, Kaplan–Meier survival curves were constructed, and the log-rank test was employed to examine the influence of intra-abdominal pressure on 28-day all-cause mortality (Fig.

结果揭示了高IAP组对CRRT治疗的更高需求（p = 0.0028）。此外，构建了Kaplan-Meier生存曲线，并使用log-rank检验来评估腹内压对28天全因死亡率的影响（图。

b). It was observed that the low-IAP group demonstrated notably higher cumulative survival rates in comparison to the high-IAP group (p = 0.001).

b). 观察到低IAP组的累积生存率明显高于高IAP组 (p = 0.001)。

Fig. 3

图 3

(

) The cumulative risk curve for CRRT utilization within the first 72 h of ICU admission. CRRT, Continuous renal replacement therapy; (

) ICU入院后72小时内的连续性肾替代治疗（CRRT）使用累积风险曲线。CRRT，连续性肾替代疗法；(

) Kaplan–Meier survival analysis curves for 28-day all-cause mortality.

28天全因死亡率的Kaplan-Meier生存分析曲线。

Full size image

全尺寸图像

Subclass analysis

子类分析

The risk stratification value of the increased IAP for primary endpoints was further analyzed in multiple subgroups of the enrolled patients, including age, gender, ICU-type, SOFA, CHF, CKD, diabetes, sepsis, first-day vasopressor and invasive MV use (Fig.

增加的IAP对主要终点的风险分层价值在入组患者的多个亚组中进行了进一步分析，包括年龄、性别、ICU类型、SOFA、CHF、CKD、糖尿病、脓毒症、第一天使用升压药和有创机械通气（图）。

). In the subgroup of individuals under 65 years old (HR: 1.4 (1.14–1.71)), males (HR: 1.47 (1.13–1.91)), those admitted to the CCU (HR: 1.84 (1.04–3.24)), those admitted to the SICU(HR: 1.42 (1.07–1.89)), those with a SOFA score greater than 6 (HR: 1.26 (1.01–1.57)), those with a SOFA score less than 6 (HR: 1.82 (1.04–3.2)), those without concurrent CHF (HR: 1.4 (1.12–1.75)), those without concurrent CKD (HR: 1.4 (1.11–1.77)), those without concurrent diabetes (HR: 1.41 (1.1–1.8)), those with concurrent sepsis (HR: 1.41 (1.14–1.75)), those administered vasopressors (HR: 1.48 (1.14–1.93)), and those not using invasive MV (HR: 1.45 (1.16–1.82)), elevated IAP remained significantly associated with the risk of AKI occurrence within 72 h..

在65岁以下个体（HR：1.4（1.14-1.71））、男性（HR：1.47（1.13-1.91））、入住CCU的患者（HR：1.84（1.04-3.24））、入住SICU的患者（HR：1.42（1.07-1.89））、SOFA评分大于6的患者（HR：1.26（1.01-1.57））、SOFA评分小于6的患者（HR：1.82（1.04-3.2））、未并发CHF的患者（HR：1.4（1.12-1.75））、未并发CKD的患者（HR：1.4（1.11-1.77））、未并发糖尿病的患者（HR：1.41（1.1-1.8））、并发脓毒症的患者（HR：1.41（1.14-1.75））、使用升压药的患者（HR：1.48（1.14-1.93））以及未使用有创机械通气的患者（HR：1.45（1.16-1.82））中，IAP升高仍与72小时内发生AKI的风险显著相关。

Fig. 4

图4

Forest plots of hazard ratios for the incidence of acute kidney injury (AKI) in different subgroups. HR, hazard ratio; ICU, intensive care unit; CCU, coronary care unit; SICU, surgery intensive care unit; SOFA, sequential organ failure assessment; CHF, chronic heart failure; CKD, chronic kidney disease; MV, mechanical ventilation..

不同亚组急性肾损伤（AKI）发生率的风险比森林图。HR，风险比；ICU，重症监护病房；CCU，冠心病监护病房；SICU，外科重症监护病房；SOFA，序贯器官衰竭评估；CHF，慢性心力衰竭；CKD，慢性肾脏病；MV，机械通气。

Full size image

全尺寸图像

Discussion

讨论

This study, utilizing the MIMIC-IV database, investigated the potential link between elevated IAP and the risk of AKI. Our findings indicate a significant association between increased IAP and the likelihood of developing AKI. Even after adjusting for potential confounders, this association remains robust, with the high IAP group exhibiting a hazard ratio (HR) of 1.23 (95% CI: 1.01–1.52) compared to the normal IAP group.

本研究利用 MIMIC-IV 数据库，调查了 IAP 升高与 AKI 风险之间的潜在联系。我们的研究结果表明，IAP 增加与发生 AKI 的可能性之间存在显著关联。即使在调整了潜在混杂因素后，这种关联仍然稳健，与正常 IAP 组相比，高 IAP 组表现出的风险比（HR）为 1.23（95% 置信区间：1.01–1.52）。

Additionally, analysis using RCS revealed a nonlinear relationship between elevated IAP and the incidence of AKI. These results underscore the importance of vigilant monitoring and management of intra-abdominal pressure..

此外，使用RCS进行的分析揭示了IAP升高与AKI发生率之间的非线性关系。这些结果强调了密切监测和管理腹内压的重要性。

There is increasing awareness regarding the monitoring of IAP in critically ill patients, particularly due to its association with a spectrum of organ dysfunctions, including AKI. According to the World Society of Abdominal Compartment Syndrome (WSACS) criteria, normal intra-abdominal pressure should not exceed 12 mmHg, and intra-abdominal pressure exceeding 20 mmHg is considered indicative of abdominal compartment syndrome (ACS).

人们对监测危重患者的腹内压（IAP）越来越重视，尤其是因为它与一系列器官功能障碍（包括急性肾损伤（AKI））相关。根据世界腹腔间隔室综合征协会（WSACS）的标准，正常的腹内压不应超过12毫米汞柱，而腹内压超过20毫米汞柱则被认为是腹腔间隔室综合征（ACS）的指标。

. While an increase in IAP is often linked with organ dysfunction, clear clinical evidence delineating this correlation remains elusive. Current research, primarily involving small-scale prospective studies, presents inconsistent findings on the relationship between elevated IAP and AKI risk. In a small-sample (n = 60) retrospective study by Demarchi et al..

虽然腹内压 (IAP) 增高常与器官功能障碍相关，但明确描述这一关联的临床证据仍然难以捉摸。当前的研究主要涉及小规模前瞻性研究，对于 IAP 升高与急性肾损伤 (AKI) 风险之间的关系得出了不一致的结果。Demarchi 等人在一项小样本（n=60）回顾性研究中...

, a correlation was found between increased IAP following abdominal surgery and a higher incidence of AKI with a calculated optimal threshold of 7.68 mmHg using the Youden index. The initial IAP measurement at ICU admission was a predictor of AKI, with an area under the receiver operating characteristic curve (AUC) of 0.669 (p < 0.029).

，发现腹部手术后腹内压 (IAP) 升高与急性肾损伤 (AKI) 发生率较高之间存在相关性，并使用约登指数计算出最佳临界值为 7.68 mmHg。ICU 入院时的初始 IAP 测量值是 AKI 的预测因子，受试者工作特征曲线下面积 (AUC) 为 0.669（p < 0.029）。

Similarly, Mazzeffi et al..

同样，Mazzeffi 等人。

reported that 35 out of 42 patients (83.3%) undergoing cardiac surgery experienced elevated IAP at least once during the perioperative period, suggesting that IAH could heighten AKI risk in this group—a finding consistent with our own results. Conversely, a prospective study

据报道，在42名接受心脏手术的患者中，有35名（83.3%）在围手术期至少经历过一次IAP升高，这表明IAH可能会增加该组患者发生AKI的风险——这一发现与我们自己的结果一致。相反，一项前瞻性研究

involving 50 obstetric patients observed no significant association between IAP and early AKI. Despite the prevalence of IAH and AKI in this cohort, the AUC for IAP in predicting early AKI was only 0.499 (95% CI: 0.325–0.673) with a p-value of 0.992, indicating no predictive value. Our study further explores this relationship through careful adjustment for related confounders.

涉及50名产科患者的观察未发现IAP与早期AKI之间存在显著关联。尽管该队列中IAH和AKI的患病率较高，但IAP预测早期AKI的AUC仅为0.499（95% CI：0.325-0.673），p值为0.992，表明无预测价值。我们的研究通过仔细调整相关混杂因素进一步探讨了这种关系。

In our fully adjusted model, the high IAP group showed a HR of 1.23 (1.01–1.52) with a p-value of less than 0.05, indicating that elevated IAP is an independent risk factor for AKI, representing a 1.23-fold increased risk of the outcome in the high IAP group compared to the low IAP group. Specifically, high IAP increased the risk of AKI by 25%.

在我们经过充分校正的模型中，高IAP组显示出1.23（1.01-1.52）的风险比（HR），p值小于0.05，表明升高的IAP是AKI的独立风险因素，与低IAP组相比，高IAP组的结果风险增加了1.23倍。具体而言，高IAP使AKI的风险增加了25%。

These findings emphasize the need for vigilant monitoring and management of intra-abdominal pressure to mitigate the risk of AKI in critically ill patients. In addition, we utilized restricted cubic spline regression to assess the nonlinear association between IAP and AKI. The results of the RCS model revealed a nonlinear escalation in the risk of AKI as IAP increased (nonlinear .

这些发现强调了需要对腹内压进行密切监测和管理，以减轻重症患者发生急性肾损伤（AKI）的风险。此外，我们利用限制性立方样条回归评估了腹内压（IAP）与急性肾损伤（AKI）之间的非线性关联。RCS模型的结果显示，随着腹内压升高，急性肾损伤的风险呈现非线性增长（非线性）。

= 0.002). As IAP continues to increase, the associated risk curve for AKI stabilizes. Additionally, we observed that a significant elevation in intra-abdominal pressure (IAP > 16 mmHg) appears to be necessary to substantially increase the risk of AKI occurrence.

= 0.002）。随着腹内压（IAP）持续升高，急性肾损伤（AKI）的相关风险曲线趋于稳定。此外，我们观察到，腹内压（IAP > 16毫米汞柱）显著升高似乎是有必要显著增加急性肾损伤（AKI）发生的风险。

In present, the pathophysiology of renal injury induced by elevated IAP remains not fully understood, but several mechanisms have been proposed. Firstly, as the post- glomerular intrarenal vascular network operates under low pressure

目前，由腹内压升高引起的肾损伤的病理生理学机制仍未完全了解，但已提出了几种机制。首先，由于肾小球后的肾内血管网络在低压下运作。

, increased IAP can compress or occlude renal veins and tubules, thereby elevating glomerular capillary output pressure. This results in increased proximal tubular pressure and reduced renal arterial inflow, ultimately diminishing the transcapillary hydrostatic pressure gradient essential for glomerular filtration.

，增加的腹内压可以压迫或闭塞肾静脉和肾小管，从而提高肾小球毛细血管输出压力。这会导致近端小管压力增加，肾动脉流入减少，最终降低对肾小球滤过至关重要的跨毛细血管静水压力梯度。

Consequently, this can lead to a reduced glomerular filtration rate, causing oliguria and renal tubular dysfunction.

因此，这可能导致肾小球滤过率降低，引起少尿和肾小管功能障碍。

. For instance, Doty et al.

。例如，Doty 等人。

observed in pigs that increasing renal venous pressure to 30 mmHg led to a substantial drop in GFR from 26 to 8 ml/min, with the changes being partially or completely reversible upon reduction of the renal venous pressure. Secondly, further increases in IAP can impact cardiovascular function by reducing cardiac preload, impairing myocardial contractility, and increasing cardiac afterload, all of which contribute to decreased cardiac output.

在猪的实验中观察到，将肾静脉压力升高至30毫米汞柱时，肾小球滤过率（GFR）从26毫升/分钟显著下降至8毫升/分钟，而当肾静脉压力降低后，这些变化部分或完全可逆。其次，腹内压（IAP）的进一步升高会影响心血管功能，通过减少心脏前负荷、损害心肌收缩力以及增加心脏后负荷，所有这些因素都会导致心输出量的下降。

This interplay may trigger cardiorenal syndrome, further exacerbating renal deterioration.

这种相互作用可能引发心肾综合征，进一步加剧肾脏恶化。

，

. Additionally, reduced cardiac function activates compensatory mechanisms, leading to elevated levels of catecholamines, renin, and angiotensin-aldosterone, along with an increase in inflammatory cytokines, which may further impair renal function

此外，心脏功能下降会激活代偿机制，导致儿茶酚胺、肾素和血管紧张素-醛固酮水平升高，同时炎症细胞因子增加，这可能会进一步损害肾功能。

，

. In summary, heightened IAP can adversely affect renal function through both indirect systemic effects and direct renal impacts, underscoring the complex interdependencies between increased abdominal pressure and renal health.

总之，腹内压升高可以通过间接的全身效应和直接的肾脏影响对肾功能产生不利影响，突显了腹压增加与肾脏健康之间复杂的相互依赖关系。

This study presents several notable advantages. First, it is pioneering in utilizing data from the MIMIC database to investigate the correlation between IAP and AKI. The large sample size employed exceeds those of previous observational studies, lending greater reliability to the findings. Second, throughout the model-building process, we accounted for potential confounding factors, enhancing the robustness of our conclusions.

本研究具有多项显著优势。首先，它开创性地利用MIMIC数据库的数据来探讨腹内压（IAP）与急性肾损伤（AKI）之间的相关性。所采用的大样本量超过了以往的观察性研究，使研究结果更具可靠性。其次，在模型构建过程中，我们考虑了潜在的混杂因素，增强了结论的稳健性。

Moreover, this study advances our understanding by exploring the nonlinear relationship between IAP and the incidence of AKI using RCS regression, thereby providing a more nuanced analysis of how variations in IAP influence AKI risk..

此外，本研究通过使用RCS回归探讨IAP与AKI发生率之间的非线性关系，进一步加深了我们的理解，从而提供了关于IAP变化如何影响AKI风险的更细致分析。

This study also has certain limitations. Firstly, it is retrospective in nature, and although we employed the multivariable regression method to minimize the influence of confounding factors and enhance the robustness of our results, these findings need to be validated through further prospective cohort studies.

本研究也存在一定的局限性。首先，本研究为回顾性研究，虽然我们采用了多变量回归的方法尽量减少混杂因素的影响，增强结果的稳健性，但这些发现还需要通过进一步的前瞻性队列研究来验证。

Secondly, patients who did not undergo intra-abdominal pressure measurement were excluded from the study. Consequently, our study population may inherently consist of individuals considered at potential risk for intra-abdominal hypertension, which could introduce a degree of selection bias. Finally, considering IAP is a dynamic parameter, relying on a single measurement may not adequately capture the relationship between its fluctuations over time and the incidence of AKI.

其次，未进行腹内压测量的患者被排除在研究之外。因此，我们的研究人群可能本身包含被认为有腹内高压潜在风险的个体，这可能会引入一定程度的选择偏倚。最后，考虑到腹内压是一个动态参数，依赖单次测量可能无法充分捕捉其随时间波动与急性肾损伤发生之间的关系。

A more comprehensive approach that accounts for the dynamic changes in IAP may provide deeper insights into its impact on AKI..

一种考虑到IAP动态变化的更全面的方法可能会提供对其对AKI影响的更深入见解。

Conclusion

结论

In summary, our research indicated that mildly elevated IAP within the range of 12–16 mmHg does not substantially raise the risk of AKI development. However, higher IAP levels are associated with increased rates of AKI, CRRT requirement, and 28-day mortality.

总之，我们的研究表明，轻度升高的IAP在12-16毫米汞柱范围内并不会显著增加AKI发生的风险。然而，较高的IAP水平与AKI发生率、CRRT需求以及28天死亡率的增加相关。

Data availability

数据可用性

Our data was obtained from MIMIC-IV2.2, This data can be found here: MIMIC-IV v2.2 (physionet.org), thus no more permission was required.

我们的数据来自MIMIC-IV 2.2，该数据可以在这里找到：MIMIC-IV v2.2 (physionet.org)，因此不需要更多许可。

Abbreviations

缩略语

AKI:

急性肾损伤：

Acute kidney injury

急性肾损伤

AUC:

The area under the curve

曲线下的面积

CCI:

CCI：

Charlson Comorbidity Index

查尔森合并症指数

CCU:

中央控制单元：

Coronary care unit

冠心病监护病房

CHF:

瑞士法郎：

Chronic heart failure

慢性心力衰竭

CI:

持续集成：

Confidence interval

置信区间

CKD:

慢性肾脏病：

Chronic kidney disease

慢性肾病

CRRT:

连续性肾脏替代治疗：

Continuous renal replacement therapy

连续性肾脏替代治疗

HR:

人力资源：

Hazards ratio

风险比

IAP:

应用内购买：

Intra-abdominal pressure

腹腔内压力

ICU:

重症监护室：

Intensive care unit

重症监护室

MIMIC:

The Medical Information Mart for Intensive Care database

医疗信息集市重症监护数据库

MV:

Mechanical ventilation

机械通气

RCS:

Restricted cubic splines

限制性立方样条

SAPSII:

Simplified acute physiology scores II

简化急性生理评分II

SD:

标准差（Standard Deviation）：

Standard deviations

标准差

SICU:

SICU: 外科重症监护室

Surgery intensive care unit

手术重症监护室

SOFA:

沙发：

Sequential Organ Failure Assessment

序贯器官衰竭评估

SQL:

Structured Query Language

结构化查询语言

WBC:

白细胞计数：

White blood cell

白细胞

References

参考文献

Malbrain, M. L. et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study.

Malbrain, M. L. 等。危重患者腹内高压的患病率：一项多中心流行病学研究。

Intensive Care Med.

重症医学科。

(5), 822–829 (2004).

Article

文章

PubMed

Google Scholar

谷歌学术

Reintam, B. A. et al. Incidence, risk factors, and outcomes of intra-abdominal hypertension in critically ill patients-a prospective multicenter study (IROI Study).

Reintam, B. A. 等。重症患者腹腔内高压的发生率、风险因素及结果——一项前瞻性多中心研究（IROI 研究）。

Crit. Care Med.

重症医学科

(4), 535–542 (2019).

Article

文章

Google Scholar

谷歌学术索

Malbrain, M. L., Cheatham, M. L., Kirkpatrick, A. et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions.

Malbrain, M. L., Cheatham, M. L., Kirkpatrick, A. 等。国际腹内高压与腹腔间隔室综合征专家会议结果。I. 定义。

Intensive Care Med.

重症医学科。

(11), 1722–1732 (2006).

Ruiz-Castilla, M. et al. Analysis of intra-abdominal hypertension in severe burned patients: the Vall d’Hebron experience.

鲁伊斯-卡斯蒂利亚，M. 等。严重烧伤患者腹腔内高压分析：巴尔德埃布隆经验。

Burns

伯恩斯

(4), 719–724 (2014).

Article

文章

CAS

中国科学院

PubMed

Google Scholar

谷歌学术索

Sun, J. et al. Intra-abdominal hypertension and increased acute kidney injury risk: a systematic review and meta-analysis.

孙杰等人。腹腔内高压与急性肾损伤风险增加：一项系统评价和荟萃分析。

J. Int. Med. Res.

国际医学研究杂志

(5), 675889741 (2021).

Article

文章

MATH

数学

Google Scholar

谷歌学术索

Suphatheerawatr, N. et al. Intra-abdominal hypertension among medical septic patients associated with worsening kidney outcomes (IAH-WK study).

Suphatheerawatr, N. 等。医疗脓毒症患者中与肾脏预后恶化相关的腹腔内高压（IAH-WK 研究）。

Med. (Baltim.)

医学。（巴尔的摩）

102

(4), e32807 (2023).

Article

文章

CAS

中国科学院

Google Scholar

谷歌学术

Dupont, V. et al. How to explain glomerular filtration rate decrease in intra-abdominal hypertension?.

杜邦，V. 等。如何解释腹腔内高压导致的肾小球滤过率下降？。

Nephrol. Ther.

肾病学与治疗。

(1), 24–28 (2018).

Article

文章

PubMed

Google Scholar

谷歌学术索

Demarchi, A. C. et al. Intra-abdominal pressure as a predictor of acute kidney injury in postoperative abdominal surgery.

德马基，A.C. 等。腹腔内压力作为腹部手术后急性肾损伤的预测指标。

Ren. Fail.

肾衰竭。

(4), 557–561 (2014).

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术索

Tyagi, A. et al. Role of intra-abdominal pressure in early acute kidney injury: a prospective cohort study in critically ill obstetric patients.

Tyagi, A. 等。腹腔内压在早期急性肾损伤中的作用：重症产科患者前瞻性队列研究。

Indian J. Crit. Care Med.

印度危重病医学杂志

(8), 602–607 (2018).

Article

文章

CAS

中国科学院

PubMed

PubMed Central

Google Scholar

谷歌学术

Chang, H. J. et al. Intra-abdominal hypertension does not predict renal recovery or in-hospital mortality in critically ill patients with acute kidney injury.

张, H. J. 等。腹腔内高压并不能预测急性肾损伤危重患者的肾功能恢复或住院死亡率。

Kidney Res. Clin. Pract.

肾脏研究与临床实践

(2), 103–108 (2015).

Article

文章

PubMed

PubMed Central

MATH

数学

Google Scholar

谷歌学术

Johnson, A. et al. MIMIC-IV, a freely accessible electronic health record dataset.

Johnson, A. 等。MIMIC-IV，一个可自由访问的电子健康记录数据集。

Sci. Data

科学数据

(1), 1 (2023).

Article

文章

CAS

中国科学院

PubMed

PubMed Central

Google Scholar

谷歌学术索

Poston, J. T. & Koyner, J. L. Sepsis associated acute kidney injury.

波斯顿，J. T. & 科纳，J. L. 脓毒症相关急性肾损伤。

BMJ

英国医学期刊

364

, k4891 (2019).

，k4891（2019）。

Article

文章

PubMed

PubMed Central

Google Scholar

谷歌学术搜索

Wang, Y. & Bellomo, R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment.

王，Y. & 贝洛莫，R. 心脏手术相关急性肾损伤：风险因素、病理生理学和治疗。

Nat. Rev. Nephrol.

自然综述：肾病学

(11), 697–711 (2017).

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术

Blazek, K. et al. A practical guide to multiple imputation of missing data in nephrology.

Blazek, K. 等。肾脏病学中缺失数据多重插补的实用指南。

Kidney Int.

肾脏国际。

(1), 68–74 (2021).

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术

Ostermann, M. et al. Controversies in acute kidney injury: conclusions from a kidney disease: improving Global Outcomes (KDIGO) Conference.

奥斯特曼，M. 等。急性肾损伤的争议：来自肾脏疾病：改善全球预后（KDIGO）会议的结论。

Kidney Int.

肾脏国际。

(2), 294–309 (2020).

Article

文章

PubMed

PubMed Central

Google Scholar

谷歌学术

Zhang, Z. Semi-parametric regression model for survival data: graphical visualization with R.

张，Z. 半参数回归模型在生存数据中的应用：使用R进行图形可视化。

Ann. Transl. Med.

安。翻译。医学。

(23), 461 (2016).

Article

文章

PubMed

PubMed Central

MATH

数学

Google Scholar

谷歌学术索

Mazzeffi, M. A. et al. Intra-abdominal hypertension and postoperative kidney dysfunction in cardiac surgery patients.

马泽菲，M. A. 等。心脏手术患者腹腔内高压与术后肾功能障碍。

J. Cardiothorac. Vasc. Anesth.

心胸血管麻醉杂志

(6), 1571–1577 (2016).

Article

文章

PubMed

Google Scholar

谷歌学术

Kon, V., Hughes, M. L. & Ichikawa, I. Blood flow dependence of postglomerular fluid transfer and glomerulotubular balance.

康，V.，休斯，M. L.，市川，I. 血流对肾小球后液体转移和肾小球小管平衡的依赖性。

J. Clin. Invest.

临床研究杂志

(5), 1716–1728 (1983).

Article

文章

CAS

中国科学院

PubMed

PubMed Central

MATH

数学

Google Scholar

谷歌学术

Mohmand, H. & Goldfarb, S. Renal dysfunction associated with intra-abdominal hypertension and the abdominal compartment syndrome.

Mohmand, H. & Goldfarb, S. 与腹腔内高压和腹腔室隔综合征相关的肾功能障碍。

J. Am. Soc. Nephrol.

美国肾脏病学会杂志

(4), 615–621 (2011).

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术

Doty, J. M. et al. Effect of increased renal venous pressure on renal function.

多蒂，J. M. 等。肾静脉压升高对肾功能的影响。

J. Trauma

创伤杂志

(6), 1000–1003 (1999).

Article

文章

CAS

中国科学院

PubMed

MATH

数学

Google Scholar

谷歌学术

Mullens, W. et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure.

Mullens, W. 等。静脉充血对晚期失代偿性心力衰竭肾功能恶化的意义。

J. Am. Coll. Cardiol.

美国心脏病学会杂志

(7), 589–596 (2009).

Article

文章

PubMed

PubMed Central

Google Scholar

谷歌学术搜索

Damman, K. et al. The cardiorenal syndrome in heart failure.

达曼，K. 等。心力衰竭中的心肾综合症。

Prog. Cardiovasc. Dis.

心血管疾病进展

(2), 144–153 (2011).

Article

文章

PubMed

Google Scholar

谷歌学术

Mikami, O. et al. High intra-abdominal pressure increases plasma catecholamine concentrations during pneumoperitoneum for laparoscopic procedures.

三上，O. 等。高腹内压在腹腔镜手术气腹期间增加血浆儿茶酚胺浓度。

Arch. Surg.

外科档案

133

(1), 39–43 (1998).

Article

文章

CAS

中国科学院

PubMed

MATH

数学

Google Scholar

谷歌学术搜索

Rezende-Neto, J. B. et al. Systemic inflammatory response secondary to abdominal compartment syndrome: stage for multiple organ failure.

雷森德-内托，J. B. 等。腹腔间隔室综合征引发的全身炎症反应：多器官衰竭的前兆。

J. Trauma

创伤杂志

(6), 1121–1128 (2002).

Article

文章

PubMed

Google Scholar

谷歌学术索

Oda, J., Ivatury, R. R., Blocher, C. R. et al. Amplified cytokine response and lung injury by sequential hemorrhagic shock and abdominal compartment syndrome in a laboratory model of ischemia-reperfusion.

小田，J.，伊瓦图里，R. R.，布洛赫，C. R. 等。在缺血再灌注的实验室模型中，顺序性失血性休克和腹腔室隔综合征放大的细胞因子反应与肺损伤。

J Trauma

创伤杂志

(4), 625–631, 632 (2002).

Download references

下载参考文献

Funding

资金

This work was sponsored by grants from Zhejiang Provincial Clinical Research Center for Critical Care Medicine.

这项工作得到了浙江省重症医学临床研究中心的资助。

Author information

作者信息

Author notes

作者笔记

These authors contributed equally: ShengHui Miao and Mingkun Yang.

这些作者贡献相同：苗盛辉和杨明坤。

Authors and Affiliations

作者与所属机构

The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, 322000, China

浙江大学医学院第四附属医院，国际医学研究院，义乌，322000，中国

ShengHui Miao

苗盛慧

Department of Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, 310053, Zhejiang, China

中国浙江省杭州市浙江中医药大学第二临床医学院，邮编310053

Mingkun Yang & Wen Li

杨明坤和李文

Zhejiang Hospital, Zhejiang University School of Medicine, Lingyin Road 12, Hangzhou, 310013, Zhejiang, China

中国浙江省杭州市灵隐路12号，浙江大学医学院附属浙江医院，邮编310013

Jing Yan

景妍

Authors

作者

ShengHui Miao

苗盛慧

View author publications

查看作者出版物

You can also search for this author in

您还可以搜索此作者在

PubMed

Google Scholar

谷歌学术

Mingkun Yang

杨明坤

View author publications

查看作者的出版物

You can also search for this author in

您还可以搜索此作者在

PubMed

Google Scholar

谷歌学术

Wen Li

李文

View author publications

查看作者的出版物

You can also search for this author in

您还可以搜索此作者在

PubMed

Google Scholar

谷歌学术

Jing Yan

景妍

View author publications

查看作者的出版物

You can also search for this author in

您还可以搜索该作者在

PubMed

Google Scholar

谷歌学术搜索

Contributions

贡献

Shenghui Miao and Mingkun Yang co-led this study. They conceptualized the research aims, planned analyses, and guided the literature review. Shenghui Miao extracted data from the MIMIC-IV database. Wen Li assisted with data processing and statistical analysis. Shenghui Miao and Mingkun Yang drafted the initial manuscript.

苗圣辉和杨明坤共同领导了这项研究。他们构思了研究目标，规划了分析，并指导了文献综述。苗圣辉从MIMIC-IV数据库中提取了数据。李文协助进行了数据处理和统计分析。苗圣辉和杨明坤起草了初稿。

Jing Yan provided feedback and approved the final manuscript. All authors reviewed and approved the final manuscript..

景艳提供了反馈并批准了最终手稿。所有作者都审查并批准了最终手稿。

Corresponding author

通讯作者

Correspondence to

致信给

Jing Yan

荆燕

。

Ethics declarations

伦理声明

Competing interests

利益冲突

The authors declare no competing interests.

作者声明不存在竞争性利益。

Ethics approval and consent to participate

伦理批准和参与同意

Use of the database was approved by the Institutional Review Boards of MIT and Beth Israel Deaconess Medical Center. As the database is anonymized and contains standardized data, this study did not require separate ethics approval per the Declaration of Helsinki. Therefore, this manuscript is exempt from the requirement for ethical approval statement and informed consent.

数据库的使用得到了麻省理工学院和贝斯以色列女执事医疗中心的机构审查委员会的批准。由于该数据库是匿名的且包含标准化数据，根据《赫尔辛基宣言》，本研究不需要单独的伦理审批。因此，本手稿免于伦理审批声明和知情同意的要求。

The participants in the study have all passed the official ethics test and are qualified to access the database..

研究的参与者都通过了官方的伦理测试，有资格访问数据库。

Additional information

附加信息

Publisher’s note

出版商说明

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Springer Nature 对已发布地图中的管辖权声明和机构隶属关系保持中立。

Rights and permissions

权利与许可

Open Access

开放获取

This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material.

本文根据知识共享署名-非商业性使用-禁止演绎 4.0 国际许可协议获得许可，该协议允许您在任何媒介或格式中进行非商业性的使用、分享、分发和复制，只要您对原作者和来源给予适当的署名，提供指向知识共享许可协议的链接，并说明是否对授权材料进行了修改。

You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

根据本许可，您无权分享从本文或其部分内容改编的材料。本文中的图像或其他第三方材料包含在文章的Creative Commons许可中，除非在材料的署名行中另有说明。如果材料未包含在文章的Creative Commons许可中，并且您的预期用途不被法律规定允许或超出了允许的使用范围，您需要直接从版权持有人处获得许可。

To view a copy of this licence, visit .

要查看此许可证的副本，请访问。

http://creativecommons.org/licenses/by-nc-nd/4.0/

。

Reprints and permissions

重印和权限

About this article

关于本文

Cite this article

引用这篇文章

Miao, S., Yang, M., Li, W.

苗，杨，李