重症医学科老年患者急性肾损伤危险因素和预后分析

Analysis of incidence, risk factors, and prognosis of acute kidney injury in elderly patients in intensive care unit

目的了解重症医学科(ICU)老年患者住院期间急性肾损伤(AKI)的发生情况、相关危险因素及预后。方法收集2012-01-01—2016-03-01安徽中医药大学第一附属医院内科ICU收治的581例老年患者的临床资料和实验室检查数据;根据改善全球肾脏病预后组织(KDIGO)标准将患者分成AKI组和非AKI组,比较两组患者的临床指标、住院时间和患者病死率;应用Logistic多元回归法分析ICU中老年患者发生AKI的危险因素。结果共119例发生AKI,发生率为20.5%,AKI患者病死率为61.3%(73例);AKI组脓毒症发生、基础慢性肾脏病(CKD)、系统急性生理学及慢性健康状况评分系统(APACHE)-Ⅱ评分、基础脑钠肽、代谢性酸中毒、液体超负荷明显高于非AKI组(P<0.05)。经Logistic多元回归分析,CKD、脓毒症、APACHE-Ⅱ评分、基础脑钠肽、代谢性酸中毒、液体超负荷是发生AKI的独立相关危险因素。AKI组患者ICU内住院时间和住院病死率显著高于非AKI组(P均<0.05),随着AKI程度的增加,患者ICU内住院时间显著延长(P<0.05),病死率显著增加(P<0.01)。结论老年患者AKI的发生率及病死率均较高,CKD、脓毒症、APACHE-Ⅱ评分、基础脑钠肽、代谢性酸中毒、液体超负荷是发生AKI的独立相关危险因素;老年患者发生AKI后预后更差。了解和预防老年患者AKI的发生及危险因素可以为改善该类患者的预后提供依据。

Objective To investigate the incidence, risk factors, and prognosis of acute kidney injury（AKI） in elderly patients in the intensive care unit（ICU）. Methods The clinical data of 581 elderly patients treated in the ICU from January 2012 to March 2016 were collected, and laboratory tests were conducted. Patients were divided into the AKI group and non-AKI group according to the KDIGO criteria; compare the clinical indexes, hospitalization time in ICU, and mortality between the two groups. The multivariable Logistic regression analysis was performed to investigate the risk factors of AKI for elderly patients. Results AKI occurred in 119 of all 581 elderly patients（20.5%） under KDIGO-AKI criteria. Among the AKI patients, 73（61.3%） died. Sepsis, basic chronic kidney disease （CKD）, APACHE Ⅱ score, high level of brain natriuretic peptide, metabolic acidosis and fluid overload in AKI group were significantly higher than those of the non-AKI group （P〈0.05）. The univariate factor Logistic regression analysis and the multivariate regression analysis showed that chronic kidney disease, sepsis, APACHE Ⅱ score, high level of brain natriuretic peptide, metabolic acidosis and fluid overload were independent risk factors related to AKI. The hospitalization time in ICU and mortality of the AKI group were significantly higher than those of the non-AKI group （both P〈0.01）. The higher severity the AKI, the longer the time staying in the ICU（P〈0.05） and the higher the mortality. Conclusion The incidence and mortality of elderly patients with AKI are higher; chronic kidney disease, sepsis, APACHE Ⅱ score, foundation of brain natriuretic peptide, metabolic acidosis and fluid overload are the independent risk factors related to AKI. The prognosis of elderly patients with acute cardiac dysfunction who develop AKI is poor. To understand the incidence and risk factors of AKI might provide evidence for improving the prognosis of the elderly patients.