重症监护病房中急性肾损伤患者发生急性呼吸窘迫综合征及不良预后的相关危险因素分析

Risk factors for acute respiratory distress syndrome and adverse prognosis in patients with acute kidney injury in intensive care unit

背景急性肾损伤(acute kidney injury,AKI)和急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)均为重症监护病房患者的常见并发症。AKI为发生ARDS的危险因素,当AKI合并ARDS时患者死亡率显著升高。目的分析重症病房中急性肾损伤患者发生急性呼吸窘迫综合征以及不良预后的相关危险因素。方法回顾性分析2013年1月1日-2020年1月1日解放军总医院第一医学中心重症监护病房AKI患者临床资料。根据是否发生ARDS分为ARDS组(154例)和非ARDS组(102例)。根据是否发生不良预后(住院死亡或出院时未脱离机械通气伴应用血管活性药物维持循环)分为不良预后组(164例)和正常出院组(92例)。通过单因素与多因素logistic回归分析AKI患者发生ARDS及不良预后的危险因素。结果校正混杂因素后结果显示,AKI 3期(OR:4.81,95%CI:2.20~10.54)、肾性AKI(OR:6.00,95%CI:2.87~12.56)和应用血管活性药物(OR:3.72,95%CI:1.70~8.12)是AKI患者发生ARDS的独立危险因素;年龄(OR:1.02,95%CI:1.01~1.04)、休克(OR:3.12,95%CI:1.62~6.00)、AKI 3期(OR:3.44,95%CI:1.61~7.35)是AKI患者发生不良预后的独立危险因素。不良预后组入院体温(OR:0.66,95%CI:0.45~0.97)更低,ICU住院时间(OR:0.99,95%CI:0.98~0.99)更短。结论AKI 3期、肾性AKI和应用血管活性药物为重症病房中AKI患者发生ARDS的独立危险因素。不良预后组入院体温更低,年龄、休克和AKI 3期为AKI患者不良预后的独立危险因素。

Background Acute kidney injury(AKI)and acute respiratory distress syndrome(ARDS)are common complications in intensive care unit(ICU)patients.AKI is a risk factor for ARDS,and the mortality of patients increases significantly when AKI is combined with ARDS.Objective To analyze the risk factors of acute respiratory distress syndrome and adverse prognosis in patients with acute kidney injury in intensive care units.Methods Clinical data about AKI patients in intensive care unit of the First Medical Center of Chinese PLA General Hospital from January 1,2013 to January 1,2020 were retrospectively analyzed.There were 154 cases in ARDS group and 102 cases in non-ARDS group.According to the occurrence of adverse prognosis,164 patients were in the adverse prognosis group and 92 patients in the normal discharge group.Univariable and multivariable logistic regression were used to analyze the risk factors of ARDS and adverse prognosis in patients with AKI.Results By adjusting confounding factors,the results of multivariable analysis showed that stage 3 AKI(OR:4.81,95%CI:2.20-10.54),renal AKI(OR:6.00,95%CI:2.87-12.56)and application of vasoactive drugs(OR:3.72,95%CI:1.70-8.12)were independent risk factors of ARDS.Age(OR:1.02,95%CI:1.01-1.04),shock(OR:3.12,95%CI:1.62-6.00)and stage 3 AKI(OR:3.44,95%CI:1.61-7.35)were independent risk factors of adverse prognosis.Patients in the poor prognosis group had lower body temperature(OR:0.66,95%CI:0.45-0.97),and shorter length of stay in ICU(OR:0.99,95%CI:0.98-0.99).Conclusion Stage 3 AKI,renal AKI and application of vasoactive drugs are independent risk factors for ARDS in patients with AKI in intensive care units.Patients with adverse prognosis have lower body temperature at admission.Age,shock and stage 3 AKI are independent risk factors for adverse prognosis.