脓毒症急性肾损伤危险因素及对预后影响318例分析

Risk factors and prognosis of septic acute kidney injury:a clinical analysis

目的分析脓毒症急性肾损伤的发生及对预后的影响。方法回顾性分析2008-01-01—2010-06-30收入中国医科大学附属一院重症加强病房(ICU)治疗的318例脓毒症患者临床资料,分为急性肾损伤组和非急性肾损伤组,应用Logistic回归对发病和死亡的相关因素进行统计学分析。结果 318例脓毒症患者中有119例发生急性肾损伤,发生率为37.4%,平均入ICU 2.4 d(0～26 d)开始出现急性肾损伤,持续时间7.8 d(1～63 d)。依发病24 h内最差指标分期:1期(危险期)74例(62.2%),2期(损伤期)18例(15.1%),3期(衰竭期)27例(22.7%)。60例患者接受持续性肾脏替代治疗(CRRT)治疗,平均CRRT时间为131.8 h(1～1008 h)。脓毒症急性肾损伤患者死亡48例(其中19例放弃治疗),占脓毒症患者的15.1%。有37例(31.1%)肾功能完全恢复,32例(26.9%)肾功能部分恢复,50例(42.0%)肾功能未恢复(其中23例拒绝CRRT治疗)。弥散性血管内凝血(DIC)、CPR术后及高SOFA评分是急性肾损伤的危险因素。高乳酸血症是脓毒症急性肾损伤患者死亡的危险因素。结论 ICU中脓毒症急性肾损伤的发生率及病死率高,DIC、CPR术后及高SOFA评分会增加脓毒症患者发生急性肾损伤的风险。高乳酸血症会增加脓毒症急性肾损伤患者的死亡风险。

Objective To analyze the incidence of septic acute kidney injury and its impact on the prognosis. Methods We did a retrospective study on clinical profiles in patients with sepsis from Intensive Care Unit （ICU） of First Affiliated Hospital of China Medical University between January 1 st ,2008 and June 30th ,2010. Patients were allocated into acute kidney injury and non-acute kidney injury group for further statistical analysis of the risk factors responsible for incidence and death by appling Logistic regression model. Results Of 318 patients with sepsis, 119 （37.4%） developed acute renal injury, which emerged at a mean time of 2.4 （ range ：0 - 16） days after admission to ICU and lasted for 7. 8 （ range ： 1 - 63 ） days. Staging based on the lowest creatinine level was categorized accordingly within 24 hours after the onset ： stage 1 （ risk phase） for 74 cases （ 62. 2% ）, stage 2 （ injury phase） for 17 cases （ 15.1% ） and stage 3 （ faliure phase ）, 17 cases （22. 7% ）,respectively. 60 patients received continuous renal replacement therapy （CRRT） at the mean time of 131.8 （range：l-1008） hours. 48 patients （15. 1% ） with septic acute kidney injury died,among whom 19 abandoned the treatment. There were 37 patients （31.1%） ,32 patients （26. 9% ） and 50 patients （42. 0% ,23 cases declined CRRT） who were noted as having complete recovery, partial recovery and no evidence of recovery, respectively. Disseminated intravascular coagulation （DIC） , cardiopulmonary resucitation （CPR） and high SOFA score were risk factors of acute kidney inury, whilst hyperlactacidemia was identified as the risk factor of death. Conclusion Patients in ICU are associated with high morbidity and mortality of septic acute kidney injury. DIC, CPR and high SOFA score may increase the risk of incidence, and hyperlactacidemia may predispose to death in patients with septic acute kidney injury.