重症监护病房急性呼吸窘迫综合征合并急性肾损伤患者行连续性肾脏替代治疗后死亡的影响因素

Influencing factors of death in intensive care unit patients with acute respiratory distress syndrome combined with acute kidney injury after continuous renal replacement therapy

目的分析重症监护病房(intensive care unit,ICU)急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)合并急性肾损伤(acute kidney injury,AKI)患者进行连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)后死亡的影响因素。方法收集2018年1月1日至2018年12月31日入住河南省人民医院综合ICU病区的ARDS合并AKI并行CRRT患者的基本特征及临床资料,按照本次住院最终治疗结果分为存活组和死亡组。存活定义为病情稳定并好转出院,死亡定义为在ICU治疗期间死亡或放弃治疗自动出院并在后续随访中确认死亡。比较两组患者的临床基本特征和CRRT情况。使用Logistic回归分析法分析患者死亡的影响因素。结果共纳入132例患者,其中死亡90例(68.2%),男性84例(63.6%),中位年龄为59(45,73)岁。与存活组比较,死亡组患者年龄、合并恶性肿瘤比例、序贯器官衰竭评估评分、器官功能障碍数和72 h累积液体正平衡比例均较高,入ICU至开始CRRT时间用时较长,平均动脉压最低值和氧合指数均较低(均P<0.05)。多因素Logistic回归分析结果显示,年龄≥60岁(OR=4.382,95%CI 1.543~12.440,P=0.006)、器官功能障碍数多(OR=1.863,95%CI 1.109~3.130,P=0.019)、序贯器官衰竭评估评分高(OR=1.231,95%CI 1.067~1.420,P=0.004)及入ICU至开始行CRRT时间用时长(OR=1.224,95%CI 1.033~1.451,P=0.020)是ARDS合并AKI患者行CRRT后死亡的独立影响因素,氧合指数高(OR=0.992,95%CI 0.986~0.998,P=0.010)是患者预后的独立保护因素。结论ARDS合并AKI患者行CRRT后病死率仍较高,年龄≥60岁、器官功能障碍数多、序贯器官衰竭评估评分高及入ICU至开始行CRRT时间用时长是患者死亡的独立影响因素,氧合指数高是患者预后的独立保护因素。

Objective To analyze the influencing factors of death in patients with acute respiratory distress syndrome(ARDS)combined with acute kidney injury(AKI)in intensive care unit(ICU)after continuous renal replacement therapy(CRRT).Methods The demographic and clinical data of ICU patients with ARDS combined with AKI after CRRT at Henan Provincial People's Hospital from January 1,2018 to December 31,2018 were collected.According to the final treatment results of this hospitalization,the patients were divided into death group and survival group.Survival was defined as the improved patient's condition and hospital discharge.Death was defined as the patient's death during the ICU hospitalization or confirmed death after abandoning treatment and automatically being discharged from the hospital in the follow-up.The basic clinical characteristics and CRRT status between the two groups were compared.Multivariate logistic regression method was used to analyze the influencing factors of death in patients.Results A total of 132 patients were enrolled,of which 90 patients(68.2%)died,with 84 males(63.6%)and median age of 59(45,73)years.Compared with the survival group,the death group had higher age,proportion of malignant tumors,sequential organ failure assessment(SOFA)score,number of organ dysfunction and proportion of positive balance of fluid accumulation at 72 hours,longer time from entering ICU to CRRT,and lower mean arterial pressure(minimum value)and oxygenation index(all P<0.05).Multivariate logistic regression analysis results showed that the age≥60 years old(OR=4.382,95%CI 1.543-12.440,P=0.006),large number of organ dysfunction(OR=1.863,95%CI 1.109-3.130,P=0.019),high SOFA score(OR=1.231,95%CI 1.067-1.420,P=0.004)and long time from ICU admission to CRRT(OR=1.224,95%CI 1.033~1.451,P=0.020)were independent influencing factors of death in patients with ARDS combined with AKI after CRRT,and high oxygenation index(OR=0.992,95%CI 0.986-0.998,P=0.010)was an independent protective factor for patients'prognosis.Conclusions The mortality of patients with ARDS combined with AKI after CRRT is still high.The age≥60 years old,large number of organ dysfunction,high SOFA score and long time from ICU admission to CRRT are independent influencing factors for death,and high oxygenation index is an independent protective factor for prognosis in patients with ARDS combined with AKI after CRRT.