ICU重症患者万古霉素相关急性肾损伤危险因素分析

Risk factors of vancomycin-related acute kidney injury in critically ill patients in ICU

目的分析重症监护病房(ICU)患者万古霉素相关急性肾损伤(AKI)现状及危险因素。方法回顾性分析广东省人民医院南海医院2017年1月—2021年5月收治的71例经万古霉素治疗的革兰阳性菌感染的ICU患者的病历资料,收集并整理患者的一般资料,包括年龄、性别、体质量指数(BMI)、基础疾病(糖尿病、高血压、合并心血管疾病、高尿酸血症、低蛋白血症、休克等)、吸烟史、饮酒史、万古霉素用药情况(平均用药时长、日剂量等)、联合用药情况[利尿剂(呋塞米等)等],根据患者万古霉素治疗期间及治疗结束后72 h内AKI发生情况,将其分为AKI组和非AKI组,以Logistic多因素回归分析探讨ICU重症患者万古霉素相关AKI的危险因素。结果本研究71例经万古霉素治疗的ICU重症患者中出现万古霉素相关AKI患者12例(AKI组),占比16.90%;剩余59例患者未出现万古霉素相关AKI(非AKI组),占比83.10%。AKI组合并高尿酸血症、低蛋白血症、休克、使用利尿剂所占比例及万古霉素日剂量均高于非AKI组,差异有统计学意义(P<0.05);Logistic多因素回归分析结果显示,合并高尿酸血症、低蛋白血症、休克、使用利尿剂、万古霉素高剂量均为ICU重症患者出现万古霉素相关AKI的危险因素(P<0.05)。结论ICU重症患者中万古霉素相关AKI的发生率较高,且合并高尿酸血症、低蛋白血症、休克、使用利尿剂、万古霉素高剂量使用的ICU患者更易诱发万古霉素相关AKI。

Objective To investigate the risk factors of vancomycin-related acute kidney injury(AKI)in the critically ill intensive care unit(ICU)patients.Methods The medical records of 71 ICU patients infected with gram-positive bacteria treated with vancomycin in Nanhai Hospital of Guangdong Provincial People's Hospital from January 2017 to May 2021 were retrospectively analyzed,and the general data of the patients were collected and collated.Including age,gender,body weight,underlying diseases(diabetes,hypertension,complicated cardiovascular disease,hyperuricemia,hypoproteinemia,shock,etc.),smoking history,drinking history,medication status of vancomycin(average duration of medication,daily dose,etc.),combination medication status[diuretics(furosemide,etc.)],According to the incidence of AKI during and within 72 h after vancomycin treatment,patients were divided into AKI group and non-AKI group.Logistic multifactor regression analysis was used to investigate the risk factors of vancomycin-related AKI in ICU patients.Results The proportions of combined hyperuricemia,hypoalbuminemia,and shock,diuretic use,and the daily dose of vancomycin of the AKI group were all significantly higher than those of the non-AKI group(all P<0.05).Logistic multivariate regression analysis showed that hyperuricemia,hypoproteinemia,shock,diuretics,and high doses of vancomycin were all risk factors for vancomycin-related AKI in severely ill ICU patients(all P<0.05).Conclusion The incidence of vancomycin-related AKI is higher in ICU severely ill patients,and ICU patients with hyperuricemia,hypoalbuminemia,shock,use of diuretics,and high-dose use of vancomycin are more likely to be complicated with vancomycin-related AKI.