终末期肾病患者围透析期感染的临床特征及预后分析

Clinical Characteristics and Prognosis of Infections in Patients with End-stage Renal Disease at Initiation Stage of Dialysis

目的:分析终末期肾病患者围透析期感染的临床特征,探讨影响该人群感染与生存结局的关联。方法:采集广东省中医院2012年01月—2017年12月进入血液透析终末期肾病患者的临床资料,并随访至2018年12月31日,获得其生存时间、临床结局等信息。采用描述性分析总结其临床特征,运用Kaplan-Meier生存曲线分析,探索不同感染亚组患者生存预后的差异。结果:共纳入478例患者,围透析期内感染190例,感染率39.75%,共有36例(18.95%)患者发生2次及以上感染事件,再入院的主要原因为呼吸系统感染。中医证型本虚证以脾肾气虚为主(84.74%),标实证以血瘀证型为主(94.74%)。感染部位以呼吸系统为主(63.68%)。与非感染组相比,感染组年龄更大,低蛋白血症以及合并有冠心病的患者比例更多。与首次感染相比,重复感染患者死亡风险增加(P<0.05)。感染组中的死亡患者普遍高龄,患有糖尿病、冠心病的比例比存活组患者多,铁转蛋白饱和度水平显著低于存活组(P<0.05)。中位随访时间为25.80(13.31,47.5)月。感染组死亡率较非感染组显著升高(35.26%vs 22.22%)(P<0.05)。Kaplan-Meier生存曲线显示感染组第1年、第6年生存率分别为85.4%、49%,中位生存期为64月。结论:终末期肾病患者围透析期发生感染几率较大,影响远期生存率,重复感染患者死亡风险增加,合并感染的冠心病患者死亡风险升高,应当引起重视,积极防治感染。

Objective:This work aimed to demonstrate the clinical characteristics of infections and the relationship between infection and survival outcome in patients with end-stage renal disease(ESRD)at initiation stage of dialysis.Methods:Clinical data of ESRD patients who initiated hemodialysis in Guangdong Hospital of Chinese Medicine during January 2012~December 2017 were collected,including basic demographic characteristics,infection events and their sites.Patients were followed up until December 31,2018 to obtain their clinical outcome.Descriptive analysis was used to summarize the clinical characteristics of infections,and the log-rank test was performed on the survival time data using kaplan-Meier survival curve to explore the difference in survival outcomes of patients in different subgroups of infection.Results:Conclusions A total of 478 patients were included,and 190 infections occurred during the peri-dialysis period,with an infection rate of 39.75%.A total of 36 patients(18.95%)had 2 or more infectious events,and the main cause of readmission was respiratory infection.The TCM evidence of deficiency was dominated by spleen and kidney qi deficiency(84.74%)and the evidence of blood stasis(94.74%).The site of infection was predominantly the respiratory system(63.68%),followed by the urinary and digestive systems.Compared to the non-infected group,the infected group was older and had a greater proportion of patients with hypoproteinemia and comorbid coronary artery disease.Patients with repeat infections had an increased risk of death compared to those with first infections(P<0.05).Patients who died in the infected group were generally older,had more diabetes and coronary heart disease than patients in the surviving group,and had significantly lower iron transferrin saturation levels than those in the surviving group(P<0.05).Median follow-up time was 25.80(13.31,47.5)months.Mortality was greatly higher in the infected group compared to the non-infected group(35.26%vs 22.22%)(P<0.05).Kaplan-Meier survival curves showed short-term survival at year 1 and long-term survival at year 6 of 85.4%and 49%in the infected group,respectively,with a median survival of 64(months).Conclusion:The incidence of infection in patients with ESRD during peridialysis is relatively high,which affects long-term survival rate and increases the risk of death in patients with repeated infection.Increased risk of death in patients with coronary artery disease with co-infection.Therefore,attention should be paid to prevent and treat infection actively.