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目的:评价基于危险因素分层的急性肾损伤（AKI）早期预警模型联合血液灌流（HP）在脓毒症患者治疗中的有效性及安全性。方法:采用前瞻性观察性先导性研究方法，选择2019年5月至12月入住兰州大学第二医院重症医学科符合脓毒症3.0诊断标准的患者作为研究对象，通过本课题组前期自行创建的AKI早期预警模型，将AKI发生风险>30%定义为AKI高风险，纳入观察组，其余患者纳入对照组。两组患者均给予常规治疗，包括原发病灶寻找与处理、抗菌药物使用和主要器官功能支持等；观察组在常规治疗基础上联合HP治疗，每日2.5 h，连续3 d。记录两组患者性别、年龄、感染部位、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）、序贯器官衰竭评分（SOFA）、平均动脉压（MAP）及血肌酐（SCr）等基线资料；于患者入重症监护病房（ICU）时及入ICU 24 h和72 h检测血白细胞介素-6（IL-6）、脂多糖（LPS）、降钙素原（PCT）等炎症指标；同时记录患者ICU住院时间、ICU病死率及出血情况。结果:最终共49例脓毒症患者纳入分析，感染部位以肺部感染为主，感染病原菌以革兰阴性（Gn -）杆菌为主〔61.2%（30/49）〕；其中30例患者AKI发生风险>30%（为观察组），其余19例患者为对照组。两组患者性别、年龄、感染部位、APACHEⅡ评分、SOFA评分、MAP等基线资料差异均无统计学意义；但观察组SCr基线值明显高于对照组（μmol/L：112.2±34.4比93.4±13.0，n P 30% was defined as AKI high risk. Patients with AKI high risk were enrolled in the observation group, and the remaining patients were enrolled in the control group. All patients were given conventional treatment, including the search and treatment of original infection sites, the use of antibiotics and main organ function support. Patients in the observation group were combined with HP treatment on the basis of conventional treatment, 2.5 hours per day for 3 days. The baseline data of gender, age, infection site, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, mean arterial pressure (MAP) and serum creatinine (SCr) were recorded. The inflammatory indexes such as interleukin-6 (IL-6), lipopolysaccharide (LPS) and procalcitonin (PCT) were detected at ICU admission, 24 hours and 72 hours after ICU admission, and the length of ICU stay, ICU mortality and bleeding were recorded.Results:Among the 49 patients with sepsis enrolled in this study, the main diagnosis was pneumonia, and Gram-negative (Gn -) bacilli were the main pathogenic bacteria [61.2% (30/49)]. Among them, 30 patients with AKI risk > 30% were in the observation group, and the remaining 19 patients were in the control group. There was no significant difference in gender, age, infection site, APACHE Ⅱ score, SOFA score, MAP or other baseline data between the two groups, but the baseline value of SCr in the observation group was significantly higher than that in the control group (μmol/L: 112.2±34.4 vs. 93.4±13.0, n P < 0.05). At ICU admission, there was no significant difference in IL-6, LPS or PCT between the two groups. However, with the extension of ICU time, the inflammatory indexes of the two groups showed a downward trend. At 24 hours after ICU admission, there was no significant difference in IL-6, LPS or PCT between the two groups. At 72 hours after ICU admission, IL-6 in the experimental group decreased significantly as compared with the control group (ng/L: 90.9±38.1 vs. 119.1±41.9, n P < 0.05), but there was no significant difference in LPS or PCT between the two groups. The length of ICU stay in the experimental group was significantly shorter than that in the control group (days: 9.77±2.76 vs. 12.47±3.85, n P 0.05). None of the 49 patients had severe bleeding events.n Conclusions:The application of a risk stratification-based model for prediction of AKI combined with HP in septic patients is feasible both in theory and in clinical practice, and shortens the length of ICU stay, but fails to effectively remove inflammatory mediators or reduce sepsis mortality. A large sample, multicenter, randomized controlled study is still needed for further verification.