恶性肿瘤相关急性肾损伤(AKI)的临床特点及预后危险因素分析

Clinical Characteristics and Prognostic Risk Factors of Malignant TumorRelated Acute Kidney Injuries

目的:分析恶性肿瘤相关急性肾损伤(acute kidney injuries,AKI)的临床特点及预后相关危险因素,为临床预防AKI及改善患者预后提供参考依据。方法:利用医院病案管理系统筛选2011年1月1日至2020年12月31日在我院住院治疗的全部患者,对恶性肿瘤相关AKI的发生率、临床特点进行统计分析,并采用Logistic回归模型分析影响恶性肿瘤相关AKI患者短期预后(住院病死率)的相关危险因素。结果:恶性肿瘤相关AKI的发生率为4.26%(679/15937)、患病率为0.45%(679/151632)、住院病死率为22.68%(154/679)。与前5年相比,近5年男性患者构成比例明显更高;实体肿瘤患者多于血液系统肿瘤患者,近5年实体肿瘤患者构成比增加明显;近5年恶性肿瘤相关AKI患者的平均年龄明显增加,血液净化治疗的比例明显降低,恶性肿瘤相关AKI的患病率持续增加;上述差异均有统计学意义(P<0.05)。单因素及多因素的Logistic回归分析显示,转移性实体肿瘤(OR:8.501,95%CI:1.493~38.251,P<0.001)、多病因所致AKI(OR:3.252,95%CI:1.678~10.541,P<0.001)及多器官衰竭(OR:19.578,95%CI:3.578~174.211,P<0.001)是恶性肿瘤相关AKI住院病死率的独立危险因素。结论:AKI是恶性肿瘤患者的常见且严重的并发症之一,具有较高的发生率,转移性实体肿瘤、多病因所致AKI及多器官衰竭是恶性肿瘤相关AKI住院病死率的独立危险因素。

Objective:To analyze the clinical characteristics and prognostic risk factors of malignant tumor-related acute kidney injuries(AKI),and provide evidence for clinical prevention of AKI and the improvement of prognosis.Methods:All inpatients in our hospital from January 1,2011 to December 31,2020 were screened by the hospital medical record management system.Incidence and clinical characteristics of malignant tumor-related AKI were statistically analyzed.Risk factors affecting the shortterm prognosis(inpatient mortality)of patients with malignant tumor-related AKI were analyzed by logistic regression models.Results:The incidence of malignant tumor-related AKI was 4.26%(679/15,937);the prevalence rate was 0.45%(679/151,632);and the in-hospital mortality rate was 22.68%(154/679).Compared to data in previous 5 years,the proportion of male patients in recent 5 years was significantly higher;and the ratio of solid tumors to hematological tumors was also higher,which means the proportion of patients with solid tumors increased significantly in recent 5 years.In recent 5 years,the average age of patients with malignant tumor-related AKI increased significantly;the proportion of blood purification treatment decreased significantly;and the prevalence rate of malignant tumor-related AKI continued to increase;and the differences were statistically significant(all P<0.05).Univariate and multivariate logistic regression analyses showed that metastatic solid tumor(OR:8.501,95%CI:1.493-38.251,P<0.001),multifactorial AKI(OR:3.252,95%CI:1.678-10.541,P<0.001)and multiple organ failure(OR:19.578,95%CI:3.578-174.211,P<0.001)were independent risk factors for in-hospital mortality of malignant tumor-related AKI.Conclusion:AKI with a high incidence is one of the common and serious complications in patients with malignant tumors.Metastatic solid tumors,AKI of multiple causes and multiple organ failure are independent risk factors of the mortality of inpatients with malignant tumor-related AKI.