住院肿瘤患者急性肾损伤预后相关影响因素

Factors related to the prognosis of acute kidney injury in hospitalized cancer patients

目的分析肿瘤患者发生急性肾损伤(acute kidney injury,AKI)及其预后的危险因素。方法回顾性分析1658例恶性肿瘤患者的临床资料,根据患者是否发生AKI分为AKI组和非AKI组,根据是否死亡将AKI患者分为死亡组和存活组。采用单因素及多因素logistic回归分析确定AKI发生及其影响预后的危险因素。结果1658例肿瘤患者中225例患者发生AKI(13.6%);其中,AKI 1期患者147例(65.3%),2期42例(18.7%),3期36例(16.0%)。225例AKI患者中80例(35.6%)死亡。多因素logistic回归分析显示,年龄>60岁、肿瘤转移、合并CKD、低白蛋白血症、高尿酸血症、存在肾前性因素、感染、尿路梗阻、使用化学治疗(简称化疗)药、使用NSAID、使用利尿剂为肿瘤患者发生AKI的独立危险因素(P<0.05,0.01)。年龄>60岁(OR=3.896,95%CI为1.432~10.601)、存在肾前性因素(OR=2.849,95%CI为1.458~5.565)、低白蛋白血症(OR=4.069,95%CI为1.959~8.448)、感染(OR=2.282,95%CI为1.180~4.411)是肿瘤患者发生AKI后死亡的独立危险因素(P<0.05,0.01)。结论肿瘤患者中AKI的发病率和病死率高。高龄、肾前性因素、低白蛋白血症、感染是肿瘤患者发生AKI及死亡的独立危险因素。

Objective To analyze the risk factors of acute kidney injury(AKI)and its prognosis in cancer patients.Methods Clinical data of 1658 malignant tumor patients were retrospectively analyzed.They were divided into AKI group and non-AKI group according to the occurrence of AKI.In addition,AKI patients were divided into death group and survival group.Univariate and multivariate analysis were used to determine the risk factors of AKI and its prognosis.Results AKI occurred in 225(13.6%,225/1658)patients and 80(35.6%,80/225)of them died.There were 147(65.3%)patients in AKI stage 1,42(18.7%)in stage 2 and 36(16.0%)in stage 3.Multivariate logistic regression analysis showed that independent risk factors for AKI in cancer patients included age>60 years old,tumor metastasis,history of chronic kidney disease(CKD),hypoalbuminemia,hyperuricemia,prerenal factors,infection,urinary tract obstruction,use of chemotherapy drugs,nonsteroidal anti-inflammatory drugs,and diuretics(P<0.05,0.01).Age>60 years old(OR=3.896,95%CI:1.432-10.601),prerenal factors(OR=2.849,95%CI:1.458-5.565),hypoalbuminemia(OR=4.069,95%CI:1.959-8.448)and infection(OR=2.282,95%CI:1.180-4.411)were independent risk factors of in-hospital death in cancer patients after AKI(P<0.05,0.01).Conclusion The incidence and mortality of AKI are high in cancer patients.Old age,prerenal factors,hypoalbuminemia and infection are independent risk factors for AKI and death in cancer patients.