重症患者发生多黏菌素B相关性急性肾损伤的危险因素

Analysis of risk factors for polymyxin B-induced acute kidney injury in critical illness patients

目的探讨重症患者发生多黏菌素B相关性急性肾损伤(AKI)的危险因素。方法将52例静脉使用多黏菌素B治疗的重症患者根据是否发生多黏菌素B相关性AKI分为AKI组(n=30)和非AKI组(n=22)。采用单因素分析法比较两组临床资料,采用多因素Logistic回归分析法分析重症患者发生多黏菌素B相关性AKI的独立危险因素,采用Oracle Crystal Ball软件对独立危险因素与AKI发生的累积概率分布进行蒙特卡洛模拟。结果与非AKI组比较,AKI组多黏菌素B用药时间较长(d:11.68±3.83 vs.15.13±3.83,P<0.05),同时使用万古霉素(9.09%vs.36.67%)、氨基糖苷类药物(27.27%vs.56.67%)或血管活性药物(68.18%vs.90.00%)的患者比例较高(均P<0.05),多黏菌素B每公斤体质量累计用药剂量(万U/kg:21.47±8.50 vs.27.77±10.96)和多黏菌素B总累计用药剂量(万U/kg:1168.18±383.45 vs.1570.00±514.71)也较高(均P<0.05)。多因素Logistic回归分析显示,每公斤体质量累计用药剂量是发生多黏菌素B相关性AKI的独立危险因素(OR=1.190,P=0.009),蒙特卡洛拟合的概率分布模型分析结果显示,当每公斤体质量累计使用多黏菌素B的剂量达到22.7万U时,发生多黏菌素B相关性AKI的风险高达75%。结论每公斤体质量累计使用多黏菌素B达到一定剂量后,应重视评估继续用药的风险。

Objective To investigate the risk factors of polymyxin B-induced acute kidney injury(AKI) in critical illness patients.Methods Fifty-two patients with intravenous injection of polymyxin B were enrolled and then were divided into the AKI group(n = 30) and non-AKI group(n = 22) according to whether the patients had polymyxin B-induced AKI.The clinical data of the two groups were compared by univariate analysis.Multiple Logistic regression analysis was used to analyze the independent risk factors of polymyxin B-induced AKI in ICU patients.Oracle Crystal Ball software was used to perform Monte Carlo simulation on the cumulative probability distribution of independent risk factors and AKI.Results Compared with the non-AKI group,AKI group had longer polymyxin B duration(d: 11.68 ± 3.83 vs.15.13 ± 3.83,P < 0.05),the higher proportion of concomitant using vancomycin(9.09% vs.36.67%,P < 0.05),aminoglycosides antibiotics(27.27% vs.56.67%,P <0.05) and vasoactive agents(68.18% vs.90.00%,P < 0.05),the higher cumulative weight-based polymyxin B dose(× 104 U/kg: 21.47 ± 8.50 vs.27.77 ± 10.96,P < 0.05) and higher cumulative polymyxin B dose(× 104 U/kg: 1168.18 ± 383.45 vs.1570.00 ± 514.71,P < 0.05).Multiple Logistic regression analysis showed that the cumulative weight-based polymyxin B dose was independent risk factor for polymyxin B-induced AKI(OR = 1.190,P = 0.009).The analysis result of the probability distribution model fitted by Monte Carlo showed that when the cumulative dose of polymyxin B per kilogram of body weight reached 227 000 U,the probability of polymyxin B-induced AKI was up to 75%.Conclusions The cumulative weight-based polymyxin B dose is independent risk factor in critical illness patients with polymyxin B-induced AKI.