肾科重症监护病房多器官功能障碍患者临床特征及转归

Characteristics and outcomes of patients with multiple organ dysfunction in renal intensive care unit

目的:回顾性分析肾科重症监护病房(RICU)多器官功能障碍(MODS)患者的临床特征及转归。方法:收集2011年10月至2021年10月国家肾脏疾病临床医学研究中心RICU收治的MODS患者资料,分析其临床特征及预后。结果:共99例MODS患者纳入本项研究,最常见的病因是感染72例(72.7%)、其余为肾综合征出血热8例(8.1%)、热射病6例(6.1%)、蛇咬伤3例(3.0%)和蜂蜇伤3例(3.0%)等。最常受累的器官/系统是肾脏99例(100%)、其余依次为肝脏84例(84.8%)、血液系统66例(66.7%)、心脏49例(49.5%)、肺48例(48.5%)、胃肠道25例(25.3%)、中枢神经系统19例(19.2%)。47例(47.5%)有慢性肾脏病病史,72例(72.7%)合并感染,47例(47.5%)为肺部感染。84例患者(84.8%)接受肾脏替代治疗,46例(46.5%)接受机械通气,61例(61.6%)使用血管活性药物升压。51例(51.5%)在入住RICU 28 d内死亡,多因素Logistic回归分析显示,受累器官/系统数量、持续性淋巴细胞减少、急性生理和慢性健康状况Ⅱ(APACHE-Ⅱ)评分是MODS患者28 d内死亡的独立危险因素。结论:RICU中MODS患者病情危重,死亡率高。重症感染是慢性肾脏病免疫抑制患者发生MODS的主要病因。除肾脏外,肝脏与血液系统是最常受累的器官。受损器官/系统数量多及免疫功能持续低下的患者死亡风险高,需引起重视。

Objective:To retrospectively investigate the clinical characteristics and prognosis of patients with multiple organ dysfunction syndrome(MODS).Methodology:Patients with MODS admitted to the renal intensive care unit(RICU)of the National Clinical Research Center of Kidney Disease,from October 2011 to October 2021 were included in the study.The clinical characteristics and treatment of the two groups were compared.Results:Among the 99 patients,the most common cause of admission was infection(72.7%),followed by hemorrhagic fever with renal syndrome(HFRS)(8.1%),heatstroke(6.1%),snake bite(3.0%)and bee stings(3.0%).The most commonly affected organs or systems were the kidneys(100%),followed by the liver(84.8%),the blood system(66.7%),the heart(49.5%),the lungs(48.5%),the gastrointestinal tract(25.3%),and the central nervous system(19.2%).There were 47 patients with pre-existing CKD,72 with co-infection,and 47 with pulmonary infection.84 patients received renal replacement therapy(RRT),46 patients received mechanical ventilation,and 61 patients received vasoactive drugs to boost blood pressure.The mortality rate was 51.5%within 28-day after admission to RICU.Multivariate Logistic regression analysis showed that the number of organs or systems involvement,persistent lymphocytopenia and APACHE-Ⅱscore were independent risk factors for death in MODS patients.Conclusion:Patients with MODS are not rare in our study and are critically ill with poor prognosis.Most patients had a previous history of chronic kidney disease,and severe infection was the main cause of MODS.In addition to the kidneys,the liver and the blood system are the most frequently involved organs systems.Patients who present with a large number of dysfunctional organs/systems and persistent immunosuppression are often at high risk of death and need to be taken seriously by clinicians.