急诊危重患者急性肾损伤发生的Logistic回归分析

Logistic regression analysis of occurrence of acute kidney injury in emergency critically ill patients

目的探讨急诊危重患者急性肾损伤(AKI)发生的相关危险因素。方法回顾性分析2019年2月至2020年12月于商丘市第一人民医院急诊科接受治疗的206例急诊危重患者急临床资料,根据治疗后3 d内有无发生AKI分为发生组(n=74)和未发生组(n=132)。比较两组患者年龄、性别、糖尿病、入院体重、吸烟、合并脓毒症、合并高血压、合并高血脂、合并心脏病、肾毒性药物、合并慢性肾病、合并肺间质纤维化、合并脏器衰竭情况,并通过多因素Logistics回归分析影响急诊危重患者发生AKI的独立危险因素。结果两组患者性别、吸烟、入院体重、合并高血脂、合并慢性肾病、合并肺间质纤维化比较,差异无统计学意义(P>0.05),发生组患者年龄>60岁,合并脓毒症、糖尿病、合并高血压、合并脏器衰竭,使用肾毒性药物的患者比例高于未发生组(P<0.05)。多因素Logistic回归分析结果显示年龄>60岁,合并脓毒症、糖尿病、合并高血压、合并脏器衰竭,使用肾毒性药物为急诊危重患者发生AKI的独立危险因素(P<0.05)。结论危急重症患者合并器官衰竭、脓毒症则发生AKI风险越大;患者年龄越大,伴有基础疾病糖尿病、高血压或使用肾毒性药物,亦可能增加AKI发生风险。

【Objective】To explore the related risk factors of occurrence of acute kidney injury(AKI)in emergency critically ill patients.【Methods】The clinical data of 206 emergency critically ill patients who received treatment in department of emergency of the hospital were retrospectively analyzed between February 2019 and December 2020.According to whether AKI occurred within 3 d after treatment,the patients were divided into occurrence group(n=74)and non-occurrence group(n=132).The age,gender,diabetes mellitus,weight at admission,smoking,sepsis,hypertension,hyperlipidemia,heart disease,nephrotoxic drugs,chronic kidney disease,pulmonary interstitial fibrosis and organ failure were compared between the two groups.Multivariate logistics regression analysis was used to analyze the independent risk factors for AKI occurrence in emergency critically ill patients.【Results】There were no statistical differences in gender,smoking,weight at admission,hyperlipidemia,chronic kidney disease and pulmonary interstitial fibrosis between the two groups(all P>0.05).The proportions of patients with age>60 years old,sepsis,diabetes mellitus,hypertension,organ failure,use of nephrotoxic drugs in occurrence group were significantly higher than those in non-occurrence group(all P<0.05).Multivariate logistic regression analysis showed that age>60 years old,presence of sepsis,diabetes mellitus,hypertension,organ failure and use of nephrotoxic drugs were independent risk factors for AKI in emergency critically ill patients(all P<0.05).【Conclusion】Critically ill patients with organ failure and sepsis have a higher risk of AKI.The advanced age,presence of underlying diseases such as diabetes mellitus and hypertension or the use of nephrotoxic drugs may also increase the risk of AKI.