老年AECOPD患者发生急性肾损伤的危险因素分析

Analysis of risk factors for acute kidney injury in elderly patients with AECOPD

目的探讨老年慢性阻塞性肺疾病急性加重(AECOPD)患者中急性肾损伤(AKI)的发病率及相关影响因素。方法回顾性分析本院2014年1月至2020年4月间收治的诊断为AECOPD的1 523例老年患者的临床资料, 记录患者的年龄、性别、合并症、基础疾病、实验室检查等临床指标, 按是否发生AKI分为AKI组(325例)与非AKI组(1 198例), 分析老年AECOPD患者发生AKI的危险因素。结果与非AKI组相比, AKI组的年龄偏高, 急性呼吸衰竭、肺性脑病、心血管疾病及肾脏病的比例更高, 白细胞、C反应蛋白、血钾水平偏高而血红蛋白、血白蛋白、血小板水平偏低(均P<0.05)。多因素logistic回归分析结果显示高龄(OR=1.06,P<0.001)、并发有急性呼吸衰竭(OR=1.49,P=0.015)、肺性脑病(OR=2.34,P=0.015), 高血压病(OR=1.38,P=0.032)、冠状动脉粥样硬化性心脏病(OR=1.54,OR=0.005)、心房颤动(OR=1.54,P=0.043)、慢性肾脏病(OR=4.48,P<0.001)及白细胞计数(OR=1.04,P=0.026)、C反应蛋白(OR=1.003,OR=0.006)、血钾(OR=1.73,P<0.001)、白蛋白水平(OR=0.95,P=0.007)均是AECOPD人群发生AKI的独立影响因素。结论 AKI在AECOPD老年人群中比较常见, 合并高血压、肺心病、冠心病、心房颤动、脑血管疾病、慢性肾脏病及出现急性呼吸衰竭或肺性脑病的患者及出现白细胞计数、C反应蛋白、血钾升高及白蛋白水平下降均提示有更高的AKI发生风险。

Objective To investigate the incidence and related factors of acute kidney injury(AKI)in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Clinical data of 1523 elderly patients diagnosed with AECOPD admitted to our hospital from January 2014 to April 2020 were retrospectively analyzed.Clinical indicators such as age,gender,comorbidities,underlying diseases and laboratory examinations were recorded.The patients were divided into AKI group(325 cases)and non-AKI group(1198 cases)according to whether AKI occurred.The risk factors of AKI in elderly patients with AECOPD were analyzed.Results Compared with non-AKI group,AKI group had higher age,higher rates of acute respiratory failure,pulmonary encephalopathy,cardiovascular disease and kidney disease,higher levels of white blood cells,Creactive protein,blood potassium and lower levels of hemoglobin,blood albumin and platelet(all P<0.05).Multivariate logistic regression analysis showed that old age(0R=1.06,P<0.001),acute respiratory failure(OR=1.49,P=0.015),pulmonary encephalopathy(OR=2.34,P=0.015),Hypertension(OR=1.38,P=0.032),coronary atherosclerotic heart disease(OR=1.54,P=0.005),atrial fibrillation(OR=1.54,P=0.043),chronic kidney disease(OR=4.48,P<0.001)and white blood cell count(OR=1.04,P=0.026),C-reactive protein(OR=1.003,P=0.006),blood potassium(OR=1.73,P<0.001),plasma albumin level(0R=0.95,P=0.007)were independent influencing factors for AKI in AECOPD population.Conclusions AKI is common in the elderly population with AECOPD.Patients with hypertension,pulmonary heart disease,coronary heart disease,atrial fibrillation,cerebrovascular disease,chronic kidney disease,acute respiratory failure or pulmonary encephalopathy,and white blood cell count,C-reactive protein,elevated blood potassium and decreased albumin levels suggest a higher risk of AKI.