ACLF合并SBP患者发生AKI的危险因素分析

Analysis of risk factors for acute kidney injury in patients with acute on chronic liver failure complicated with spontaneous bacterial peritonitis

目的探讨慢加急性肝衰竭(ACLF)合并自发性细菌性腹膜炎(SBP)患者发生急性肾损伤(AKI)的危险因素。方法回顾性分析ACLF合并SBP患者AKI的发生率,对患者的一般情况、ACLF病因、实验室指标、有无合并其他部位感染以及初始抗感染治疗是否有效进行单因素及多因素分析。结果 370例ACLF合并SBP患者中,AKI的发生率为41.4%(153/370)。单因素分析发现,与未发生AKI的患者相比,发生AKI患者年龄、血WBC计数、总胆红素(TBil)、国际标准化比值(INR)以及C反应蛋白(CRP)均明显增高,分别为(51.5±41.6岁)比(48±11.1岁);(12.4±7.3)×10~9/L比(8.8±5.3)×10~9/L;(375.4±136.9)μmol/L比(347.8±121.2)μmol/L;(2.3±0.9)比(2.0±0.6);(37.1±32.8)μg/L比(23.0±19.2)μg/L,(均P<0.05),而平均动脉压(MAP)、血清白蛋白(Alb)、血清Na^+水平以及初始抗感染治疗的有效率均明显降低(86.9±13.8)mmHg比(90.6±9.9)mmHg;(26.6±5.6)g/L比(28.7±8.3)g/L;(130.3±5.4)μmol/L比(133.5±4.5)μmol/L;57.0%比75.7%,(均P<0.05)。Logistic多因素分析发现,患者的年龄、WBC计数、血清Na^+、CRP水平以及初始抗感染治疗是否有效是影响ACLF合并SBP患者发生AKI的重要因素。发生AKI的患者治疗无效率显著高于未发生者(60.1%比39.2%,P<0.05)。结论 ACLF合并SBP患者易发生AKI。患者年龄较大、WBC计数、CRP水平升高、血清Na+降低以及早期抗感染无效是发生AKI的高危因素。

Objective To study the risk factors for acute kidney injury(AKI)in patients with acute on chronic liver failure(ACLF)complicated with spontaneous bacterial peritonitis(SBP).Methods The incidence of AKI in ACLF patients complicated with SBP was retrospectively analyzed.Basic information,etiology of ACLF,laboratory indexes,co-infection and the efficacy of early anti-infection therapy were analyzed using univariate and multivariate analysis.Results The incidence ofAKI was 41.4%(153/370)in ACLF patients complicated with SBP.It was observed that age,white blood cell(WBC)count,total bilirubin level,international normalized ratio and C reactive protein(CRP)level were higher in patientswith AKI than those in patientswithout,respectively[(51.5土41.6 years old vs.48土11.1 years old,(12.4土7.3)X109/Lvs.(8.8土5.3)X109/L,375.4土136.9^mol/L vs.347.8土121.2^mol/L,2.3土0.9 vs.2.0土0.6,37.1土32.8 ug/L vs.23.0土19.2 ug/L,all P<0.05].However,levels of mean arterial pressure,albumin,serum Na+and the response rate of initial anti-infection therapy were lower in patients with AKI than those in patients without,respectively(86.9土13.8 mmHg vs.90.6土9.9 mmHg,26.6土5.6 g/L vs.28.7土8.3 g/L,130.3土5.4^mol/Lvs.133.5土4.5^mol/L,57.0%vs.75.7%,P<0.05).It is revealed that age,WBC count,serum Na+level,CRP level and the efficacy of early anti-infection therapy were associated with the development of AKI in ACLF patients with SBP.Moreover,treatment failure was more often inpatientswithAKI(60.1%vs.39.2%,P<0.05).Conclusion ACLFpatientswith SBP are predisposed to AKI.The risk factors include old age,increased WBC count,high CRP level,low serum Na+level and ineffective initial anti-infection therapy.