急性肾损伤患者预后影响因素分析

Analysis of risk factors affecting prognosis of the patients with acute kidney injury

目的对于急诊抢救过程中的AKI患者研究资料鲜有报道。文中分析急性肾损伤(AKI)患者临床特征及预后相关危险因素。方法回顾性分析东部战区总医院2019年6月至2020年7月期间收治的271例AKI患者临床资料,并根据患者28 d的生存情况分为存活组(n=229)和死亡组(n=42)。采用单因素及多因素Logistic回归分析AKI患者28 d死亡的独立危险因素。结果271例患者平均(50.49±19.67)岁,男女比例为1.74∶1,其中1期64例(23.6%)、2期42例(15.5%)、3期165例(60.9%)。多因素Logistic回归分析显示,高龄(OR=1.047,95%CI:1.015~1.079,P=0.003)、合并冠心病(OR=12.772,95%CI:2.775~58.773,P=0.001)及慢性肾病(OR=3.470,95%CI:1.193~10.089,P=0.022)、使用血管活性药物(OR=16.973,95%CI:3.263~88.288,P=0.001)、合并脓毒症(OR=5.341,95%CI:1.666~17.123,P=0.005)、高SOFA评分(OR=1.266,95%CI:1.047~1.532,P=0.015)以及高D二聚体(OR=1.071,95%CI:1.012~1.135,P=0.019)是AKI患者预后不良的危险因素(P<0.05)。联合上述指标建立模型预测AKI患者预后不良的ROC曲线下面积为0.940(0.904~0.965),预测效能高。结论高龄、合并冠心病、慢性肾脏病、使用血管活性药物、合并脓毒症、高D-二聚体水平及高SOFA评分与AKI患者预后不良密切相关,可作为评估预后的指标。

Objective To analyze the clinical features and prognostic risk factors of patients with acute kidney injury(AKI)in the emergency room.Methods A retrospective analysis of the clinical data of 271 patients with AKI admitted to the emergency room of the General Hospital of the Eastern Theater Command,PLA from June 2019 to July 2020 was conducted.According to the 28 day status,patients were divided into survival group(n=229)and death group(n=42),and univariate and multivariate logistic regression analysis were performed to analyze the independent risk factors of 28d death in AKI patients.Results Among 271 patients,the average age was 50.49±19.67 years old,and the male to female ratio was 1.74:1.There were 64 cases(23.6%),42 cases(15.5%)and 165 cases(60.9%)respectively in AKI stage 1,2,and 3.Multivariate logistic regression analysis showed that advanced age(OR=1.047,95%CI:1.015-1.079,P=0.003),complicated with coronary heart disease(OR=12.772,95%CI:2.775-58.773,P=0.001)and chronic kidney disease(OR=3.470,95%CI:1.193-10.089,P=0.022),use of vasoactive drugs(OR=16.973,95%CI:3.263-88.288,P=0.001),complicated with sepsis(OR=5.341,95%CI:1.666-17.123,P=0.005),high SOFA scores(OR=1.266,95%CI:1.047-1.532,P=0.015)and high D-dimer levels(OR=1.071,95%CI:1.012-1.135,P=0.019)were risk factors for poor prognosis in patients with AKI(P<0.05).Combined with the above indicators,the area under the ROC curve for predicting the poor prognosis of AKI patients to establish a model with the above indicators was 0.940(0.904-0.965),and the prediction efficiency was high.Conclusion Advanced age,coronary heart disease,chronic kidney disease,use of vasoactive drugs,sepsis,high D-dimer level and high SOFA scores were closely related to the poor prognosis of patients with AKI,and may be used as indicators to evaluate the prognosis.