多器官功能障碍综合征合并急性肾损伤患者预后的相关因素分析

Related factors affecting the prognosis of acute kidney injury in patients with multiple organ dysfunction syndrome

目的探讨影响多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)合并急性肾损伤(acute kidney injury,AKI)患者预后的相关因素。方法回顾性分析解放军总医院第一附属医院肾内科收治的101例MODS合并AKI患者的临床资料,根据其住院期间预后分为死亡组(55例)和好转组(46例),比较2组影响因素的差异,采用多因素Logistic回归分析影响预后的因素。结果 101例患者中总死亡例数为55例(占54.5%)。AKIⅢ期的病死率(66.1%)明显高于AKIⅠ期(36.4%)和AKIⅡ期(40.0%),差异有统计学意义(P<0.05)。与AKIⅠ期相比,AKIⅡ期和AKIⅢ期患者的急性生理学及慢性健康状况Ⅱ(Acute Physiology and Chronic Health Evaluation,APACHEⅡ)评分[AKIⅠ期为(20.2±5.0)分、AKIⅡ期为(24.8±5.8)分、AKIⅢ期为(29.5±7.1)分]、序贯性器官衰竭评估(Sepsis-related Organ Failure Assessment,SOFA)评分[(8.5±2.2)分、(10.6±2.8)分、(12.9±3.0)分]、器官衰竭数[(2.6±0.5)个、(3.8±1.2)个、(5.6±1.9)个]、机械通气率(31.8%、65.0%、86.4%)、血管活性药物使用率(22.7%、55.0%、78.0%)均明显升高(均P<0.05);与AKIⅡ期相比,AKIⅢ期患者的以上指标也明显升高(均P<0.05)。与好转组相比,死亡组的年龄[(52.3±16.8)岁比(63.4±18.1)岁]、APACHEⅡ评分[(19.1±5.2)分比(32.8±7.3)分]、SOFA评分[(8.7±2.3)分比(13.8±3.2)分]、器官衰竭数[(3.3±1.0)个比(5.7±1.8)个]、机械通气率(47.8%比89.1%)和血管活性药物使用率(37.0%比81.8%)均明显升高(均P<0.05)。多因素Logistic回归分析显示AKI分期、APACHEⅡ评分、器官衰竭数和机械通气率是MODS合并AKI的危险因素。结论 MODS合并AKI患者的预后受到多个因素的影响,AKI分期、APACHEⅡ评分、器官衰竭数、机械通气率是其主要危险因素。

Objective To investigate the related factors affect the prognosis of acute kidney injury （AKI） in patients with multiple organ dysfunction syndrome （MODS）. Methods The clinical data of 101 cases of MODS complicated with AKI in the First Affiliated Hospital of PLA General Hospital were retrospectively analyzed. According to the prognosis of patients during hospitalization, the patients were divided into death group and improved group. The differences in factors affecting prognosis between the two groups were compared using multivariate Logistic regression analysis. Results Out of 101 patients, there were 55 deaths （54. 5%）. The mortality in AKⅢ stage （66. 1%） was significantly higher than that in the AKIⅠ （36. 4%） and AKIⅡ stages （40. 0%） （χ2 = 5. 818, 4. 223, P 〈0. 05）. As compared with AKI I stage, acute physiology and chronic health evaluation （APACHE Ⅱ ） score （20. 2± 5.0 vs. 24. 8 ± 5.8 vs. 29. 5 ± 7. 1）, sepsis-related organ failure assessment （SOFA） score （8. 5 ± 2. 2 vs. 10. 6 ± 2. 8 vs. 12. 9 ± 3. 0）, the number of organ failure （2. 6 ± 0. 5 vs. 3. 8 ± 1.2 vs. 5, 6 ± 1.9）, mechanical ventilation rate （31.8% vs. 65.0% vs. 86. 4%） and vasoactive drug usage （22. 7% vs. 55. 0% vs. 78. 0%） in AKIⅡ and AKIⅢstages were significantly increased （P〈0. 05 for all）. The above indicators in AKIⅢ stage were also significantly higher than in AKI Ⅱ stage （P〈0.05）. Compared with the improved group, age （52. 3 ± 16. 8 vs. 63. 4 ± 18. 1）, APACHE Ⅱ score （19. 1 ± 5. 2 vs. 32. 8 ± 7. 3）, SOFA score （8. 7 ±2. 3 vs. 13. 8 ± 3. 2）, the number of organ failure （3. 3 ± 1.0 vs. 5. 7 ± 1.8）, mechanical ventilation rate （47. 8% vs. 89. 1%） and vasoactive drug usage （37. 0% vs. 81.80/40） were significantly increased in death group （P〈0. 05 for all）. Logistic regression analysis showed that AKI stage, APACHE Ⅱ score, the number of organ failure and mechanical ventilation rate were the risk factors of MODS complicated with AKI. Conclusions The prognosis of MODS patients with AKI is affected by several factors. The main risk factors are AKI stage, APACHE Ⅱ score, the number of organ failure and mechanical ventilation rate.