老年脓毒症并发急性肾损伤患者肾功能恢复的影响因素

Influencing factors of renal function recovery in elderly septic patients with acute kidney injury

目的 探讨老年脓毒症并发急性肾损伤(AKI)患者肾功能恢复的影响因素。方法 回顾性分析2019年1月至2022年9月儋州市人民医院收治的137例老年脓毒症并发AKI患者的临床资料。根据AKI确诊后90 d肾脏功能恢复情况,将患者分为恢复组(62例)和未恢复组(75例),比较2组患者的基线资料、生化指标、血常规指标及感染指标情况。采用SPSS 22.0统计软件进行数据分析。根据数据类型,分别采用t检验、Mann-Whitney U检验或χ2检验进行组间比较。应用logistic回归分析老年脓毒症并发AKI患者肾功能未恢复的独立危险因素。绘制受试者工作特征(ROC)曲线评估各独立危险因素预测老年脓毒症并发AKI患者肾功能未恢复的价值。应用Spearman相关分析血镁水平与各临床指标的相关性。结果 多因素logistic回归分析结果显示,高龄(OR=1.982,95%CI 1.376~3.150)、合并贫血(OR=4.938,95%CI 4.152~13.290)、高尿素(OR=1.772,95%CI 1.195~2.716)、高血肌酐(SCr)(OR=2.105,95%CI 1.419~3.702)、高红细胞分布宽度(RDW)(OR=5.370,95%CI 4.826~14.353)、低镁血症(OR=4.712,95%CI 3.973~12.650)、连续肾脏替代疗法(CRRT)持续时间长(OR=1.942,95%CI 1.308~3.025)、少尿或无尿持续时间长(OR=1.873,95%CI 1.306~2.980)、肾毒性药物使用(OR=5.520,95%CI 4.973~16.228)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分高(OR=2.183,95%CI 1.552~3.894)、乳酸(OR=3.115,95%CI 2.317~9.913)、C反应蛋白(CRP)(OR=2.773,95%CI 1.985~6.214)及降钙素原(PCT)(OR=4.928,95%CI 4.105~14.106)水平升高是影响老年脓毒症并发AKI患者肾功能未恢复的独立危险因素(P<0.05)。ROC曲线分析显示,10项危险因素联合预测肾功能未恢复的ROC曲线下面积最高(0.962,95%CI 0.901~0.998),灵敏度为98.6%,特异度为85.2%。结论 高龄、贫血、高尿素、高SCr、高RDW、低镁血症、CRRT持续时间长、少尿或无尿持续时间长、肾毒性药物使用、APACHEⅡ评分高、乳酸、CRP及PCT水平升高是影响老年脓毒症并发AKI患者肾功能未恢复的危险因素,10项联合预测老年AKI患者肾功能未恢复具有较高的价值。

Objective To explore the influencing factors of recovery of renal function in the elderly septic patients with acute kidney injury(AKI).Methods A retrospective analysis was made of the clinical data of 137 elderly septic AKI patients in Danzhou People′s Hospital from January 2019 to September 2022.According to the recovery of renal function on 90 days after the diagnosis of AKI,they were divided into recovery group(n=62)and non-recovery group(n=75).The two groups were compared in baseline data,biochemical indicators,routine blood indicators,and infection indicators.SPSS statistics 22.0 was used for data analysis.According to the data type,comparisons between the two groups were performed by t-test or Mann-Whitney U test.Logistic regression was used to analyze the independent risk factors of non-recovery of renal function in the elderly septic AKI patients,and receiver operating characteristic(ROC)curve was drawn to evaluate the value of each independent risk factor in predicting non-recovery of renal function in them.Spearman correlation analysis was used to analyze the correlation between blood magnesium level and clinical indicators.Results Multivariate logistic regression analysis showed that old age(OR=1.982,95%CI 1.376-3.150),companied with anemia(OR=4.938,95%CI 4.152-13.290),high urea(OR=1.772,95%CI 1.195-2.716),high serum creatinine(SCr)(OR=2.105,95%CI 1.419-3.702),high red blood cell distribution width(RDW)(OR=5.370,95%CI 4.826-14.353),hypomagnesemia(OR=4.712,95%CI 3.973-12.650),long duration of continuous renal replacement therapy(CRRT)(OR=1.942,95%CI 1.308-3.025),long duration of oliguria or anuria(OR=1.873,95%CI 1.306-2.980),use of nephrotoxic drugs(OR=5.520,95%CI 4.973-16.228),high acute physiology and chronic health evaluationⅡ(APACHEⅡ)score(OR=2.183,95%CI 1.552-3.894),high lactic acid(OR=3.115,95%CI 2.317-9.913),high C-reactive protein(CRP)(OR=2.773,95%CI 1.985-6.214)and high procalcitonin(PCT)(OR=4.928,95%CI 4.105-14.106)were independent risk factors of the failed recovery of renal function in the elderly septic AKI patients(P<0.05).The ROC curve analysis showed that 10 risk factors in combination had the highest area under ROC curve(0.962,95%CI 0.901-0.998)in predicting the failed recovery of renal function with a sensitivity of 98.6%and a specificity of 85.2%.Conclusion The old age,companied with anemia,high urea,high SCr,high RDW,hypomagnesemia,long duration of CRRT,long duration of oliguria or anuria,use of nephrotoxic drug,high APACHEⅡscore,high lactic acid,high CRP and high PCT are the risk factors of the non-recovery of renal function in the elderly septic AKI patients,and the combination of the 10 factors has high predictive value.