单中心急性肾损伤的短期预后调查分析

Short-term prognosis of acute kidney injury:A single center analysis

目的调查单中心的急性肾损伤(AKI)患者的患病情况及短期预后,分析AKI不良预后的影响因素。方法回顾性分析2015年1月1日至2018年12月31日在我院住院的AKI患者的临床资料,从诊断AKI日期随访至诊断AKI当次住院的出院日期。结果纳入研究的AKI患者2807例,7.8%的AKI患者死亡,20.4%肾功无好转或恶化,35.9%肾功部分恢复,22.1%肾功完全恢复。AKI的1期、2期及3期比例分别为27.0%、21.9%和51.1%,分期越重病死率越高。多因素回归分析提示:年龄、住ICU、心衰、多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)、休克、酸中毒、非肾内科干预是AKI全因死亡的危险因素(均P<0.05);除上述因素外,吸烟、蛋白尿、呼衰是AKI肾功能不恢复的危险因素(均P<0.05)。生存分析表明,肾内科干预组的预后累积生存率显著高于非肾内科干预组(P<0.001)。结论AKI病死率较高,肾功恢复率偏低。年龄、住ICU、心功能、MODS、休克、酸中毒和是否肾内科干预是AKI短期预后的影响因素,而肾内科干预有助于改善不良预后。

Objective To investigate the prevalence and short-term prognosis of patients with acute kidney injury(AKI),and to explore the risk factors of poor prognosis.Methods We conducted a single center study.Clinical data of AKI patients from January 1,2015 to December 31,2018 were analyzed retrospectively.And the follow-up was implemented from the confirmation of AKI to the discharge.Results A total of 2807 patients with AKI were enrolled in the study.Of the total,7.8%of the patients died;20.4%had no recovery of renal function;35.9%partial recovery,and 22.1%complete recovery.The rate of AKI stage 1,2,and 3 was 27.0%,21.9%,and 51.1%,respectively.The higher the stage,the higher the fatality rate.Multivariate regression analysis showed that advanced age,ICU admission,cardiac insufficiency,MODS,and shock,acidosis,and non-nephrological interventions were risk factors for all-cause death from AKI(all P<0.05).In addition,smoking,proteinuria,and respiratory failure are risk factors for the failure of renal function recovery in AKI(all P<0.05).Survival analysis showed that patients with nephrology intervention had a lower risk of renal failure than those without(P<0.001).Conclusion AKI leads tohigher mortality and lower renal function recovery rate.Important factors affecting AKI short-term prognosis include age,ICU admission,cardiac insufficiency,MODS,shock,acidosis,and with nephrology intervention or not.Nnephrology intervention helps improve the poor prognosis.