连续性肾脏替代治疗对脓毒症合并急性肾损伤患者预后的影响因素分析

Analysis of the prognostic factors in patients with sepsis combined with acute kidney injury after continuous renal replacement therapy

目的探讨连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)对脓毒症合并急性肾损伤(acute kidney injury,AKI)患者预后的影响因素,为提高患者生存率、改善预后提供参考依据。方法选择2014年1月至2017年12月本院肾脏科重症监护病房收治的182例脓毒症合并AKI患者为研究对象,所有患者入院后均积极治疗原发疾病,给予常规对症支持治疗,明确AKI诊断后均于48小时内接受CRRT,根据随访28天后患者的病情转归情况,将死亡的患者纳入预后不良组,存活的患者纳入预后良好组。对比两组患者的年龄、性别、基础疾病、机械通气情况、入住ICU时间、血肌酐、尿素氮、降钙素原、B型钠尿肽、血白蛋白、血钾、血镁、血磷、白细胞计数、血红蛋白、血小板、胱抑素C(Cystatin C,CysC)、尿量、平均动脉压(mean arterial pressure,MAP)、急性生理功能与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、序贯器官衰竭估计(sequential organ failure assessment,SOFA)评分、AKI分期、CRRT治疗时间、器官衰竭情况等可能影响预后的因素并进行单因素及多因素Logistic回归分析。结果 182例脓毒症合并AKI患者接受CRRT的病死率为51.6%,其中预后不良组94例,预后良好组88例。经单因素及多因素Logistic回归分析显示:CysC≥3 mg/L、MAP≤80 mmHg、APACHEⅡ评分≥20分、AKI分期Ⅲ期均为接受CRRT的脓毒症合并AKI患者预后的独立危险因素(P_均<0.05)。结论脓毒症合并AKI患者接受CRRT仍具有较高的死亡率,同时CysC水平、MAP、APACHEⅡ评分及AKI分期可作为判断患者预后的重要参考依据,应针对高危因素给予积极的干预措施,以改善患者预后。

Objective To explore the prognostic factors in patients with sepsis combined with acute kidney injury （AKI） after continuous renal replacement therapy （CRRT）, and to provide reference for improving the survival rate and prognosis of patients. Method From January 2014 to December 2017, 182 patients with sepsis combined with AKI were selected as subjects. All patients were treated with CRRT within 48 hours after AKI diagnosis. According to the prognosis of patients after 28 days of follow-up, the dead patients were included in poor prognosis group and the survivors were included in good prognosis group. Univariate and multivariate Logistic regression analysis was used to analyze the prognostic factors such as age, gender, underlying diseases, mechanical ventilation, ICU stay, serum creatinine, urea nitrogen, procalcitonin, B-type natxiuretic peptide, albumin, serum kalium, serum magnesium, serum phosphorus, numeration of leukocyte, hemoglobin, platelet, cystatin C （CysC）, urine volume, mean arterial pressure （MAP）, acute physiology and chronic health evaluation II （APACHE II ） score, sequential organ failure assessment （SOFA） score, AKI stage, CRRT treatment time, and organ failure. Result In this study, the mortality of 182 patients with sepsis combined with AKI treated with CRRT was 51.6%. 94 patients in poor prognosis group, and 88 patients in good prognosis group. Univoxiate and Logistic regression analysis showed that the CysC ≥ 3 mg/L, MAP ≤ 80 mmHg,APACHE Ⅱ score ≥ 20 points andAKI stage III were independent risk factors affecting the prognosis of patients with sepsis combined with AKI treated by CRRT （Pall 〈 0.05）. Conclusion CRRT treatment for sepsis combined with AKI still has a high mortality rate, and the factors such as CysC level, MAP level, APACHE Ⅱ score and AKI stage are important risk factors affecting the prognosis of patients, which can be used as an important reference for judging the prognosis of patients. Active intervention measures should be taken to improve the prognosis of patients.