恙虫病患者发生急性肾损伤的危险因素及死亡预测因素

To analyze risk factors and mortality predictors in acute kidney injury patients with scrub typhus

目的分析恙虫病患者发生急性肾损伤(acute kidney injury,AKI)的临床特征、危险因素和AKI患者死亡的预测因素.方法回顾性分析南方医科大学珠江医院2009年1月至2019年7月因恙虫病住院患者114例,分为AKI组和非AKI组,其中AKI组36例,分析两组临床资料,运用多因素二分类Logistic回归分析法分析AKI发生的危险因素和死亡预测因素.结果本研究中恙虫病患者AKI发生率为31.4%,AKI患者的病死率为38.9%.AKI组慢性肾病比例、血尿比例更高,血清谷丙转氨酶、胆红素、肌酸激酶、乳酸脱氢酶、超敏C反应蛋白、降钙素原水平更高,而血红蛋白、血小板、白蛋白水平更低,差异有统计学意义(P<0.05).其中贫血(OR=4.7)、降钙素原(OR=6.1)和胆红素(OR=4.0)升高为恙虫病患者发生AKI的独立危险因素.AKI患者中存活22例,死亡14例,与存活组比较死亡组年龄更大,急性生理学及慢性健康状况评估系统Ⅱ(APACHEⅡ)评分、休克发生率、肾替代治疗(renal replacement therapy,RRT)率更高,氧合指数更低,差异有统计学意义(P<0.05).其中高龄(OR=3.2)、休克(OR=2.1)、RRT(OR=1.7)比例升高为恙虫病AKI患者死亡的预测因素.结论贫血、降钙素原和胆红素升高为恙虫病患者发生AKI的独立危险因素.高龄、休克、RRT比例升高为恙虫病AKI患者死亡的预测因素.早期发现和处理高危因素能否降低AKI发生率和预后还需进一步研究.

Objective To investigate clinical characteristics,risk factors and mortality predictors in acute kidney injury(AKI) patients with scrub typhus.Methods We retrospectively evaluated a total of 114 patients diagnosed with scrub typhus,which were divided into AKI group(36 cases) and non-AKI group(n=78 cases).Clinical information was recorded and analyzed.Multivariate binary Logistic regression analysis was used to analyze the risk factors and mortality predictors of AKI.Results The incidences of AKI was 31.4%,and the mortality rate of AKI patients was 38.9% in the patients with scrub typhus.Patients in AKI group had higher incidences of chronic kidney disease and hematuresis,the higher levels of alanine transaminase,bilirubin,creatine kinase,lactate dehydrogenasr,hypersensitive C-reactive protein and procalcitonin compared with non-AKI group,and lower serum levels of hemoglobin,platelet,albumin in AKI group(P <0.05).Binary Logistic regression analysis showed anemia(OR=4.7),the elevated levels of procalcitonin(OR=6.1)and bilirubin(OR=4.0) were independent predictors of AKI in patients with scrub typhus.There were22 patients recovered and 14 patients died in AKI group.Patients in AKI death group were older,and had higher APACHE Ⅱ score,higher percentages of shock incidence,and renal replacement therapy(RRT) and lower oxygenation index,compared with AKI survival group(P <0.05).Binary Logistic regression analysis showed older age(OR=3.2),increased incidence of shock(OR=2.1),RRT(OR=1.7) were independent predictors of death in AKI patients with scrub typhus.Conclusion Our current results suggest that the presence of anemia(OR=4.7),the elevated levels of procalcitonin(OR=6.1)and bilirubin(OR=4.0) are important risk factors to determine the occurrence of AKI.Moreover,older age(OR=3.2),increased incidence of shock(OR=2.1),RRT(OR=1.7) are independent predictors of death in AKI patients with scrub typhus.It needs further study about whether early detection and treatment of high-risk factors can decrease the incidence and prognosis of AKI.