多黏菌素B相关性急性肾损伤危险因素的真实世界研究

A real-world study of risk factors for polymyxin B-related acute kidney injury

目的研究多黏菌素B相关性急性肾损伤(AKI)的发生情况及危险因素,为多黏菌素B的安全使用提供依据。方法回顾性分析武汉市第三医院2018年1月1日至2022年6月30日使用多黏菌素B患者的临床资料,根据2012版全球肾病预后组织(KDIGO)急性肾损伤临床实践指南对AKI发生情况进行分析,比较AKI组与非AKI组之间基线资料、合用药物及多黏菌素B的使用情况,将具有统计学意义的因素与其他重要临床因素纳入Logistic回归模型,分析AKI发生的危险因素。结果研究共纳入101例患者,按照标准排除后有65例,有27例患者发生AKI(发生率为41.54%),其中1期12例(44.44%),2期9例(33.33%),3期6例(22.22%);发生AKI的患者中有5例(18.52%)患者行肾脏替代治疗(CRRT),17例(62.96%)患者最终肾功能恢复,10例(37.04%)患者死亡、转院或出院。单因素分析显示,AKI组合用血管活性药物、给予负荷剂量、低蛋白血症(<25 g/L)的例数显著多于非AKI组(21 vs.20,15 vs.12,20 vs.14,P<0.05),多因素Logistic回归分析显示,低蛋白血症(<25 g/L)为多黏菌素B相关性AKI的独立危险因素(OR=0.032,P=0.021)。结论与非AKI组相比,多黏菌素B相关性AKI组更多地合用血管活性药物、更多给予负荷剂量。低蛋白血症(<25 g/L)为多黏菌素B相关性AKI的独立危险因素。

Objective To study the occurrence and risk factors of polymyxin B-related acute kidney injury(AKI),and to provide evidence for the safe use of polymyxin B.Methods A retrospective analysis of the clinical data of patients using polymyxin B in Wuhan Third Hospital from January 1,2018 to June 30,2022 was performed.The incidence of AKI was analyzed according to the 2012 edition of the Global Kidney Disease Outcomes Organization(KDIGO)clinical practice guidelines for acute kidney injury;the baseline data,the use of concomitant drugs and polymyxin B were compared between the AKI group and the non-AKI group;the statistically significant factors and other important clinical factors were included in the Logistic regression model to analyze the risk factors of AKI.Results A total of 101 patients were included in the study,65 patients were included according to the standard,and 27 patients had AKI(incidence rate 41.54%),including 12 patients(44.44%)in stage 1,9 patients(33.33%)in stage 2,and 6 patients(22.22%)in stage 3;5 patients(18.52%)with AKI underwent continuous renal replacement therapy(CRRT),17 patients(62.96%)eventually had renal function recovered,and 10 patients(37.04%)died,transferred or discharged.Univariate analysis showed that the cases of combined use of vasoactive drugs,taking a loading dose,and being with hypoalbuminemia(<25 g/L)(21 vs.20,15 vs.12,20 vs.14)in AKI group were more than those in non-AKI group(P<0.05);multivariate Logistic regression analysis showed that hypoalbuminemia(<25 g/L)was an independent risk factor for polymyxin B-related AKI(OR=0.032,P=0.021).Conclusion The polymyxin B-related AKI group is more frequently in combination with vasoactive drugs and in loading doses than the non-AKI group.Hypoproteinemia(<25 g/L)is an independent risk factor for polymyxin B-related AKI.