呼吸衰竭后急性肾损伤患者的预后及危险因素分析

Analysis of the Prognosis and Risk Factors of Acute Kidney Injury after Respiratory Failure

目的:探讨呼吸衰竭后急性肾损伤(acute kidney injury,AKI)患者的预后及其危险因素。方法:选择2006年1月至2008年12月于上海交通大学医学院附属仁济医院呼吸科与内科重症监护室住院的235例诊断为呼吸衰竭的临床资料完整的患者,比较发生AKI的患者发病前后的临床资料和实验室检查结果,进一步采用多因素COX回归方程分析与呼吸衰竭后AKI预后相关的独立危险因素。结果:总共纳入235例呼吸衰竭患者,发生AKI患者(77例)的生存率明显低于未发生AKI者(P<0.001)。225例呼吸衰竭(剔除10例放弃治疗出院患者)死亡患者中,AKI发生率[65.6%vs 20.1%,P<0.001]显著高于存活组患者。多因素COX回归分析显示AKI分期(HR=1.362)更是呼吸衰竭患者住院死亡的独立危险因素;呼吸衰竭后AKI死亡患者的白细胞计数[(13.31±4.44)×10~9vs(10.77±3.76)×10~9,P=0.011]、利尿剂应用比例[92.5%vs 72.7%,P=0.023]、呼吸机脱机失败比例[100.0%vs 23.1%,P<0.001]、多器官功能衰竭(multiple organ failure,MOSF)的发生率[65.0%vs 0%,P<0.001]均显著高于存活患者,而血白蛋白(blood albumin)ALB[31.91±4.92 vs 34.70±5.14 g/L,P=0.021]低于存活患者。多因素COX回归分析提示呼吸机脱机失败(HR=15.50)、MOSF(HR=2.72)为呼吸衰竭发生AKI患者住院死亡的独立危险因素。结论:呼吸衰竭后发生AKI的患者死亡率高,AKI分期是呼吸衰竭患者住院死亡的独立危险因素之一。呼吸机脱机失败和MOSF是呼吸衰竭后AKI的患者住院死亡的独立危险因素。

Objective： To determine the prognosis and risk factors of acute kidney injury（AKI） after respiratory failure patients.Methods： 235 patients diagnosed as respiratory failure admitted in the Internal Medicine Intensive Care Unit and Respiratory Division in Renji Hospital, Shanghai Jiaotong University School of Medicine from January, 2006 to December, 2008 were retrospectively analyzed.The clinical data and laboratory tests before and after AKI were compared. The clinical risk factors of prognosis of AKI in respiratory failure patients were analyzed. Multivariate COX regression analysis was used to investigate the independent risk factors of prognosis of AKI in these patients. Results： Of the total 235 patients diagnosed as respiratory failure, the survival rate of AKI patients was significantly lower than those without AKI（P〈0.001）. In 225 respiratory failure patients（excluding 10 patients giving up treatment to discharge）, the incidence of AKI in death was higher than in survival（65.6 % vs 20.1 %, P〈0.001）. Multivariate COX regression analysis showed that AKI stage（HR=1.362） was the independent risk factor of mortality in hospital of respiratory failure patients. Of 77 cases of AKI in respiratory failure patients（excluding 4 patients giving up treatment to discharge）, leukocyte count [（13.31＋4.44） ×10^9 vs（10.77＋3.76）×10^9,P=0.011], proportion of diuretics application（92.5 % vs 72.7 %, P=0.023）, rate of ventilator weaning failure（100.0 % vs 23.1 %,P〈0.001）, incidence of multiple organ failure（MOSF） [65.0 % vs 0 %, P〈0.001） were significantly higher in death than in survival, and ALB [31.91＋4.92 vs. 34.70＋5.14 g/L, P = 0.021） was lower in death than in survival. Multivariate COX regression analysis suggested that ventilator weaning failure（HR=15.50）, MOSF（HR=2.72） were independent risk factors of death in hospital of AKI in respiratory failure patients. Conclusions： AKI stage was the independent risk factor of death in hospital of respiratory failure patients. Ventilator weaning failure and MOSF were independent risk factors of AKI in respiratory failure patients.