脓毒症并发急性肾损伤患者临床特征及危险因素分析

Analysis on clinical characteristics and risk factors in patients with septic AKI

目的分析脓毒症并发急性肾损伤（AKI）的临床特征及危险因素。方法回顾性分析2013年1～12月151例脓毒症患者的临床资料，分为AKI组与非AKI组，比较两组一般情况及常规实验室检查结果，分析脓毒症并发AKI患者的临床特征。用Logistic回归对脓毒症性AKI发病及死亡的危险因素进行统计学分析。结果151例患者中67例并发AKI，发生率为44．4％。40例AKI患者死亡，病死率为59．70％。AKI患者的年龄、心率、白细胞、SAPS评分、降钙素原、乳酸、血管活性药物及呼吸机使用率、病死率高于非AKI患者，平均动脉压（MAP）、血钠、血小板低于后者（P均〈0．05）。多因素Logistic回归分析显示，高SAPS评分（OR：1．065，P=0．022）、高白细胞（OR：1．066，P=0．015）、心率快（OR：1．047，P=0．021）、低MAP（OR：0．971，P=0．029）、血小板减少（OR：0．996，P=0．019）、低钠（OR：0．923，P=0．012），糖尿病（OR：3．561，P=0．010）、慢性肾脏病（CKD）（OR：1．018，P=0．030）是脓毒症患者并发AKI的独立危险因素。高乳酸（OR：0．372，P〈0．05）是脓毒症并发AKI患者死亡的危险因素。结论白细胞和血小板计数、SAPS评分、心率、MAP、血钠有助于脓毒症性AKI的早期识别。血乳酸值与脓毒症AKI患者的预后相关。

Objective To analyze clinical characteristics and risk factors of acute kidney injury （AKI） in patients with sepsis. Methods This study retrospectively analyzed the baseline characteristics and laboratory data of 151 patients with sepsis from the emergency ward of Tianjin General Hospital from January to December 2013. Patients were allocated into AKI group and non-AKI group for further analysis of clinical characteristics. The multivariable Logistic regression was applied to investigate risk factors for the progression and death of AKI. Results Of 151 patients with sepsis, 67 （44A%） developed AKI. Of 67 patients with septic AKI, 40 （59.70%） died. Patients with septic AKI were older, and had higher heart rates, WBC （white blood cell）, higher SAPS score, higher PCT （procalcitonin） and lactate level, lower MAP （mean arterial pressure）, lower Na, lower platelet accounts compared with patients with nonseptic AKI. The multivariable Logistic regression analysis revealed that the development of septic AKI was associated with high SAPS score, low MAP, high WBC, low platelet accounts, low blood Na level, high heart rates, diabetes mellitus, CKD （chronic kidney disease）. Hyperlactacidemia was identified as the risk factor for the death. Conclusion SAPS score, WBC, platelet accounts, MAP, blood Na value, heart rates were associated with the development of AKI in petients with sepsis. Blood lactic acid value is related to the prognosis of patients with septic AKI.