合并急性肾损伤患者体外膜肺氧合支持上机后28 d肾功能未恢复的独立危险因素

Independent risk factors for renal function non-recovery at 28 days after ECMO initiation among patients receiving ECMO complicated with acute kidney injury

目的探究接受接受体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持治疗且合并急性肾损伤(acute kidney injury,AKI)患者上机后28 d肾功能恢复情况及影响因素。方法回顾性收集2019年10月至2021年12月广西壮族自治区人民医院急诊监护病房收治的ECMO支持治疗且合并AKI患者的临床资料,根据患者上机28 d后的肾脏功能恢复情况分为肾功能恢复组和肾功能未恢复组。以28 d时肾功能未恢复为研究终点,选择差异有统计学意义的变量进行逐步向后回归,确定独立危险因素。绘制受试者工作特性(receiver operator characteristic,ROC)曲线,使用曲线下面积(area under the curve,AUC)评估独立危险因素的诊断价值。结果共纳入40例患者,其中28 d时肾功能恢复28例(70%),未恢复12例(30%)。逐步向后多因素logistic回归结果提示上机时乳酸水平是28 d肾功能未恢复的独立危险因素(OR=1.380,95%CI:1.096~1.738,P=0.006)。ROC曲线显示AUC和95%CI为0.863(0.751~0.975),敏感度为100%,特异度为75%。结论ECMO辅助且合并AKI的患者,上机时乳酸水平是28 d时肾功能未恢复的独立危险因素。上机时乳酸对患者肾功能能否恢复具有较高的预测价值。

Objective To investigate the recovery of renal function and its influencing factors in patients receiving extracorporeal membrane oxygenation(ECMO)support and complicated with acute kidney injury(AKI).Methods This was a retrospective observational study.The clinical data of patients with ECMO support and AKI admitted to the Emergency intensive care unit of the People's Hospital of Guangxi Zhuang Autonomous Region from October 2019 to December 2021 were collected.The patients were divided into renal function recovery group and renal function non-recovery group according to the recovery of renal function after 28 days of ECMO.With renal function non-recovery at 28 days as the end point of the study,and the variables with significant differences in baseline were selected for stepwise backward regression to determine the independent risk factors.The receiver operator characteristic(ROC)curve was drawn,and the area under the curve(AUC)was used to evaluate the diagnostic value of independent risk factors.Results A total of 40 patients were enrolled,of which 28 patients(70%)had recovery of renal function,and 12 patients(30%)did not have recovery of renal function.Stepwise backward multivariate logistic regression analysis showed that lactate level at ECMO initiation was an independent risk factor for non-recovery of renal function(OR=1.380,95%CI:1.096-1.738,P=0.006).The ROC curve showed that the AUC and 95%CI were 0.863(0.751-0.975),the sensitivity was 100%,and the specificity was 75%.Conclusion Lactate level at ECMO initiation was an independent risk factor for non-recovery of renal function on 28 days after ECMO initiation among patients undergoing ECMO support complicated with AKI.Lactate has a high predictive value for the non-recovery of renal function.