甲状腺功能减退对内科危重症患者急性肾损伤的发生及临床预后的影响

The impact of hypothyroidism on the incidence and clinical prognosis of acute kidney injury in critically ill patients

目的探讨在内科危重症患者中甲状腺功能减退与急性肾损伤(acute kidney injury,AKI)的发生之间的关系,同时分析甲状腺功能减退对发生AKI的内科危重症患者临床预后的影响。方法纳入广州中医药大学顺德医院重症医学科住院的危重症患者共496例,其中28例诊断患有甲状腺功能减退症(甲减组),468例未诊断出甲状腺功能减退症(非甲减组)。分析两组患者AKI的发生率,采用Logistic回归分析探讨甲状腺功能减退症与危重症患者并发AKI之间的关系;统计两组患者中发生AKI的患者的资料,分析甲状腺功能减退对AKI患者临床预后包括死亡率、连续性肾脏替代治疗比例和住ICU时间的影响。结果甲状腺功能减退危重患者AKI的发生率高于非甲状腺功能减退危重患者(57.1%vs 29.9%,χ2=9.085,P=0.003),以AKI 2期和3期为主;合并甲状腺功能减退的AKI患者住院期间住院死亡率(56.3%vs 31.4%,P=0.047)和ICU住院时间[10(7,13)d vs 7(4,9)d,P=0.035]均高于非甲状腺功能减退的AKI患者,差异均具有统计学意义;而两组患者行连续性肾脏替代治疗的比例未见统计学差异(31.3%vs 21.4%,P=0.372)。多因素Logistic回归分析甲状腺功能减退(OR:1.478,95%CI:1.217~1.579,P=0.027)、较高的APACHE II评分(OR:1.898,95%CI:1.765~2.089,P=0.008)、使用肾毒性抗生素(OR:1.428,95%CI:1.312~1.521,P=0.042)和脓毒症(OR:2.283,95%CI:2.197~2.489,P=0.035)是内科危重症患者发生AKI的独立危险因素。结论甲状腺功能减退可增加内科危重症患者AKI的发生风险,并且可增加AKI危重症患者的死亡率和ICU住院时间,影响危重症AKI患者的临床预后,应该引起临床医生足够的重视。

Objective To explore the relationship between hypothyroidism and acute kidney injury(AKI)in critically ill patients,and to investigate the impact of hypothyroidism on clinical prognosis of critically ill patients with AKI.Methods A total of 496 critically ill patients from internal intensive care unit of Shunde Hospital of Guangzhou University of Traditional Chinese Medicine were enrolled in this study,28 cases were diagnosed with hypothyroidism(hypothyroidism group)and 468 cases were not coexisted with hypothyroidism(non-hypothyroidism group).The incidences of AKI for the two groups were analyzed,and the relationship between hypothyroidism and AKI in critically ill patients were explored by logistic regression analysis.We summarized the clinical data of patients with AKI to analyze the impact of hypothyroidism on the clinical prognosis,in the aspects including mortality rate,proportion of continuous renal replacement therapy and intensive care unit stay duration in this study.Results The incidence of AKI in critically ill patients with hypothyroidism was higher than that in critically ill patients without hypothyroidism(57.1%vs 29.9%,χ2=9.085,P=0.003),and most of AKI cases were AKI stage 2 and 3.The mortality during hospitalization(56.3%vs 31.4%,P=0.047)and intensive care unit stay duration[10(7,13)day vs 7(4,9)day,P=0.035]in critically ill AKI patients with hypothyroidism were higher than those without hypothyroidism,with the difference of statistical significance.However,there was no statistical differences in the proportion of continuous renal replacement therapy between the two groups(31.3%vs 21.4%,P=0.372).Multivariate logistic regression analysis showed that hypothyroidism(OR:1.478,95%CI:1.217~1.579,P=0.027),higher APACHE II score(OR:1.898,95%CI:1.765~2.089,P=0.008),medical history of nephrotoxic antibiotics(OR:1.428,95%CI:1.312~1.521,P=0.042)and sepsis(OR:2.283,95%CI:2.197~2.489,P=0.035)were independent risk factors for AKI in critically ill patients.Conclusions Hypothyroidism may increase the risk for AKI in critically ill patients,also increase mortality and longer intensive care unit stay duration of the patients,affect clinical prognosis of critically ill patients,and should be concerned fully.