高龄急性肾损伤患者连续性肾脏替代治疗的预后及影响因素

Prognosis and its influencing factors in elderly AKI patients after continuous renal replacement therapy

目的探讨高龄老年急性肾损伤(AKI)患者连续性肾脏替代治疗(CRRT)后的预后及影响因素。方法回顾性分析中日友好医院肾病科2016年1月至2023年1月的≥80岁高龄AKI患者接受CRRT治疗90 d后的生存情况,及其治疗剂量、急性生理和慢性健康状况评估Ⅱ(APACHEⅡ)和序贯器官衰竭评估(SOFA)评分。结果43例年龄(91.3±6.6)岁的AKI患者CRRT 90 d后,生存12例、死亡31例,总死亡率72.1%。APACHEⅡ评分死亡患者(27.2±4.2)明显高于生存患者(24.0±5.0)(P<0.05)。CRRT治疗15 d、30 d和45 d的累积生存率分别为71.8%、56.8%和43.2%。Logistic回归分析显示APACHEⅡ评分和SOFA评分是患者预后的独立影响因素(P<0.05)。结论高龄AKI患者CRRT治疗后的死亡率随APACHEⅡ评分增高而升高。APACHEⅡ评分和SOFA评分是高龄AKI患者开始CRRT治疗和预后的影响因素。

Objective To investigate the outcomes and influencing factors of elderly patients with acute kidney injury(AKI)after continuous renal replacement therapy(CRRT).Methods Data of elderly AKI patients aged≥80 were collected who received CRRT treatment for 90 days in the hospital from January 2016 to January 2023.Analysis was performed in their survival status,treatment dose,and scores of acute physiological and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA).Results After 90 days of CRRT in 43 AKI patients aged(91.3±6.6),12 patients survived and 31 died,with a total mortality rate of 72.1%.The APACHEⅡscores of the dead patients(27.2±4.2)were significantly higher than those of the surviving patients(24.0±5.0)(P<0.05).The cumulative survival rates of CRRT treatment for 15 days,30 days,and 45 days were 71.8%,56.8%,and 43.2%,respectively.Logistic regression analysis showed that APACHEⅡscore and SOFA score were independent influencing factors to affect the prognosis of the patients(P<0.05).Conclusion The mortality rate of the elderly AKI patients after the CRRT treatment increased with the increase of APACHEⅡscore.The APACHEⅡscore and SOFA score were the influencing factors in the initiation of CRRT treatment and prognosis for the elderly AKI patients.