重症监护病房中脓毒症患者并发急性肾损伤的危险因素分析

Risk Factors for Sepsis Associated-Acute Kidney Injury in Intensive Care Unit Patients

目的探讨重症监护病房(intensive care unit, ICU)中脓毒症患者发生急性肾损伤(acute kidney injury, AKI)相关的危险因素。方法回顾性分析2009年3月-2016年6月收治于四川大学华西医院ICU的脓毒症患者资料。收集患者一般资料、基础疾病史、ICU住院天数、并发症、实验室资料等相关数据。通过单因素及多因素logistic回归分析模型分析筛选出脓毒症并发AKI(sepsis associated-acute kidney injury, SA-AKI)发生的独立危险因素。结果共纳入符合标准的脓毒症患者2 331例,其中636例发生AKI,1 695例未发生AKI。多因素logistic回归分析结果显示,年龄>40岁〔比值比(odds ratio, OR)=2.752〕,基础疾病包括糖尿病(OR=2.563)、高血压/冠心病(OR=1.851)、慢性肾脏病(OR=15.876),住院期间并发心力衰竭(OR=2.295)、急性呼吸窘迫综合征(OR=2.067)、重症急性胰腺炎(OR=2.725)、低血压(OR=2.140)、低蛋白血症(OR=1.596)、乳酸性酸中毒(OR=2.164)、器官衰竭数>1个(OR=4.480),白细胞>10×109 L-1(OR=4.166),基础肌酐值(OR=4.401)、降钙素原(OR=1.816)、胱抑素C(OR=7.046)较高,轻度(OR=2.107)、中度(OR=3.817)、重度(OR=6.091)贫血均为发生SA-AKI的独立危险因素。结论在ICU中,慢性肾脏病史、胱抑素C较高和器官衰竭等多种危险因素与SAAKI的发生有关,认识SA-AKI的危险因素并进行监测,进而早期预防AKI的发生,可以改善脓毒症患者的预后。

Objective To explore the risk factors of acute kidney injury(AKI) in patients with sepsis in intensive care unit(ICU). Methods The medical records of patients diagnosed with sepsis in ICU of West China Hospital of Sichuan University from March 2009 to June 2016 were retrospectively analyzed. Differences between AKI group and Non-AKI group in general data, background disease, ICU entry and exit dates, complications, laboratory data and other related data were analyzed through univariate and multivariate statistical methods. Results A total of 2 331 patients with sepsis were included in the study, including 626 patients in the AKI group and 1 695 patients in the NonAKI group. The multivariate logistic regression analysis revealed that age >40 yr.(odds ratio(OR) =2.752), diabetes(OR=2.563), hypertension/coronary heart disease(OR=1.851), chronic kidney disease(OR=15.876), heart failure(OR=2.295), acute respiratory distress syndrome(OR=2.067), severe acute pancreatitis(OR=2.725), hypotension(OR=2.140), hypoproteinemia(OR=1.596), lactic acidosis(OR=2.164), organ failure>1(OR=4.480), WBC>10×109 L-1(OR=4.166), serum creatinine(OR=4.401), PCT(OR=1.816), Cys-C(OR=7.046), mild anemia(OR=2.107), moderate anemia(OR=3.817), and severe anemia(OR=6.091) were all independent risk factors of SA-AKI. Conclusion Several risk factors are related to the occurrence of SA-AKI in the ICU. Early identification and monitoring of risk factors for SAAKI and early prevention of AKI can improve the prognosis of sepsis patients.