新生儿重度窒息并发急性肾损伤的危险因素及近期预后分析

Risk Factors and Short-term Prognosis of Severe Neonatal Asphyxia Complicated with Acute Kidney Injury

背景新生儿急性肾损伤(AKI)早期诊断困难,病死率高,而目前关于重度窒息并发新生儿AKI的相关研究相对缺乏。目的探讨新生儿重度窒息并发AKI的危险因素及近期预后情况,并分析相关因素的预测价值,以采取措施减少AKI的发生,并提高此类患儿的抢救成功率。方法纳入2016年1月—2023年1月于蚌埠医学院第一附属医院新生儿重症监护病房住院治疗的172例重度窒息新生儿为研究对象,根据患儿是否并发AKI,分为AKI组(n=43)和非AKI组(n=129)。收集患儿临床资料和实验室检查结果,并记录AKI患儿的近期预后情况(住院期间存活或死亡)。采用多因素Logistic回归分析探究新生儿重度窒息并发AKI的影响因素,采用受试者工作特征(ROC)曲线探究相关指标对新生儿重度窒息并发AKI的预测价值。结果AKI组患儿胎龄、出生体质量、5 min Apgar评分、血小板计数低于非AKI组,昏迷状态比例、有创机械通气比例、合并呼吸衰竭比例、血胱抑素C(Cys C)高于非AKI组(P<0.05)。多因素Logistic回归分析结果显示,5 min Apgar评分(OR=1.553,95%CI=1.193~2.021,P=0.001)、有创机械通气(OR=2.965,95%CI=1.021~8.611,P=0.046)、血Cys C值(OR=0.231,95%CI=0.109~0.487,P<0.001)是新生儿重度窒息并发AKI的影响因素。ROC曲线分析结果显示血Cys C预测AKI的ROC曲线下面积(AUC)为0.777(95%CI=0.701~0.854,P<0.05),5 min Apgar评分预测AKI的AUC为0.792(95%CI=0.715~0.869,P<0.05)。AKI组患儿住院病死率为51.2%(22/43),非AKI组患儿住院病死率为21.7%(28/129),AKI组患儿病死率高于非AKI组(χ^(2)=13.572,P<0.001)。结论低5 min Apgar评分、有创机械通气、出生后高血Cys C会增加重度窒息新生儿发生AKI的风险。5 min Apgar评分、出生后血Cys C是预测新生儿重度窒息并发AKI的可靠指标。

Background Early diagnosis of acute kidney injury(AKI)in neonates is difficult with a high mortality rate.However,there is currently a lack of research on severe neonatal asphyxia complicated with AKI.Objective To investigate the risk factors and short-term prognosis of neonatal asphyxia complicated with AKI,and analyze the predictive value of related factors,so as to take measures to reduce the occurrence of AKI and improve the success rate of resuscitation of the neonates.Methods A total of 172 neonates with severe asphyxia who were hospitalized in the Neonatal Intensive Care Unit of the First Affiliated Hospital of Bengbu Medical College from January 2016 to January 2023 were included as the study subjects and divided into AKI group(n=43)and non-AKI group(n=129)according to whether the neonates were complicated with AKI.Clinical data and laboratory results were collected,and the short-term prognosis(survival or death during hospitalization)of the children with AKI was recorded.Multivariate Logistic regression analysis was used to explore the influencing factors of severe neonatal asphyxia complicated with AKI,and receiver operating characteristics(ROC)curve was used to explore the predictive value of related indicators for severe neonatal asphyxia complicated with AKI.Results Gestational age,birth weight,5-min Apgar score and platelet count in AKI group were lower than those in non-AKI group,and the proportions of coma,invasive mechanical ventilation and combined respiratory failure,cystatin C(Cys C)were higher than those in non-AKI group,with statistically significant difference(P<0.05).Multivariate Logistic regression analysis showed that 5-min Apgar score(OR=1.553,95%CI=1.193-2.021,P=0.001),invasive mechanical ventilation(OR=2.965,95%CI=1.021-8.611,P=0.046)and blood Cys C value(OR=0.231,95%CI=0.109-0.487,P<0.001)were the influential factors for severe neonatal asphyxia complicated with AKI.ROC curve analysis showed that the AUC of blood Cys C for predicting AKI was 0.777(95%CI=0.701-0.854,P<0.05),and the AUC of 5-min Apgar score for predicting AKI was 0.792(95%CI=0.715-0.869,P<0.05).The hospitalized mortality was 51.2%(22/43)in AKI group and 21.7%(28/129)in non-AKI group,and the mortality in AKI group was higher than that in non-AKI group,the difference was statistically significant(χ^(2)=13.572,P<0.001).Conclusion Low 5-min Apgar score,invasive mechanical ventilation,and high postnatal blood Cys C can increase the risk of AKI in neonates with severe asphyxia.Postnatal blood Cys C and 5-min Apgar Score are reliable predictor of neonatal asphyxia complicated with AKI.