血钙水平与伴有高钙血症的急性肾损伤患者预后的相关性分析

Correlation between serum calcium level and prognosis of acute kidney injury patients with hypercalcemia

目的分析血钙水平与伴有高钙血症的急性肾损伤(acute kidney injury,AKI)患者生存预后和肾功能恢复预后的相关性。方法回顾性分析2015年12月至2022年8月上海交通大学医学院附属第一人民医院各科收治的伴有高钙血症的AKI患者的临床资料,纳入研究对象157例。以出院时为观察终点,观察患者在这段时间内的生存情况和肾功能恢复情况。根据出院时的生存情况,将患者分为生存组(116例)和死亡组(41例);根据出院时的肾功能恢复情况,将生存患者分为肾功能恢复组(63例)和肾未恢复组(53例)。符合正态分布的连续变量以x^(-)±s表示,两组组间均数比较采用独立样本t检验;不符合正态分布的连续变量以中位数(四分位数)[M(Q1,Q3)]表示,两组间采用Mann-Whitney U检验进行比较。分类变量以频数(百分比)表示,根据不同的适用情况选择χ^(2)检验及Fisher确切概率法进行比较。血钙水平与研究对象预后的相关性采用单因素及多因素Logistic回归分析。结果研究对象的年龄为(68.37±16.28)岁,男性97例(61.78%)。生存组和死亡组的年龄分别为(65.39±16.13)、(76.80±13.67)岁,男性分别为66、31例,恶性肿瘤病史(除多发性骨髓瘤外)分别为37、23例,白蛋白分别为(35.41±6.84)、(30.82±5.75)g/L,生存组和死亡组在年龄、性别、恶性肿瘤病史(除多发性骨髓瘤外)、白蛋白的差异均有统计学意义(统计量值分别为t=4.04、χ^(2)=4.49、χ^(2)=7.51、t=3.85;均P<0.05)。肾功能恢复组和未恢复组AKI分级1级的构成比分别为33.33%(21/63)、64.15%(34/53),2级分别为36.51%(23/63)、24.53%(13/34),3级分别为30.16%(23/63)、11.32%(6/34),出院血钙分别为(2.50±0.38)、(2.70±0.58)mmol/L,住院血钙分别为(2.60±0.29)、(2.78±0.39)mmol/L,血钙最低值分别为(2.28±0.36)、(2.50±0.51)mmol/L,B型钠尿肽分别为118(64,283)、248(69,1383)ng/L,肾功能恢复组和未恢复组在AKI分级、出院血钙、住院血钙、血钙最低值、B型钠尿肽的差异均有统计学意义(统计量值分别为χ^(2)=11.84、t=2.26、t=2.75、t=2.73、U=2.62;均P<0.05)。多因素Logistic回归分析结果显示,年龄(OR=1.062,95%CI 1.027~1.098,P<0.001)、恶性肿瘤病史(除多发性骨髓瘤外)(OR=3.811,95%CI 1.623~8.951,P=0.002)、白蛋白降低(OR=0.889,95%CI 0.829~0.953,P=0.001)是影响患者院内死亡的独立危险因素;AKI严重程度(AKI2级OR=2.984,95%CI 1.281~6.954,P=0.011,AKI3级OR=5.280,95%CI 1.863~14.963,P=0.002)、出院血钙升高(OR=0.813,95%CI 0.666~0.992,P=0.041)是影响患者早期肾功能恢复的独立危险因素。结论血钙水平与伴有高钙血症的AKI患者的院内死亡风险无关,而与早期肾功能恢复预后有关。积极控制血钙、治疗肿瘤原发病及纠正低蛋白血症有助于改善此类患者的预后。

Objective To analyze the correlation between serum calcium levels and the prognosis of survival and renal recovery in patients with acute kidney injury(AKI)accompanied by hypercalcemia.Methods This retrospective study analyzed the clinical data of patients with AKI accompanied by hypercalcemia admitted to Shanghai General Hospital from December 2015 to August 2022.There were 157 patients included in the study.The observation endpoint was set at discharge,focusing on the patients'survival and renal recovery during this period.Based on their status at discharge,patients were divided into a survival group(116 cases)and a death group(41 cases);and among the survivors,into a renal recovery group(63 cases)and a non-recovery group(53 cases).Continuous variables conforming to normal distribution were expressed as x^(-)±s,and the mean comparison between the two groups was performed using an independent sample t-test.Continuous variables not conforming to normal distribution were represented by median(interquartile range)and compared between groups using the Mann-Whitney U test.Categorical variables were expressed as frequency(percentage),and comparisons were made using the chi-squared(χ^(2))test or Fisher's exact test,as applicable.The correlation between serum calcium levels and patient outcomes was analyzed using univariate and multivariate Logistic regression.Results The average age of the study subjects was(68.37±16.28)years,with 97 males(61.78%).The ages in the survival and death groups were(65.39±16.13)years and(76.80±13.67)years,respectively,with 66 males in the survival group and 31 in the death group.The history of malignancy(excluding multiple myeloma)was 37 cases and 23 cases,respectively,and serum albumin levels were(35.41±6.84)g/L and(30.82±5.75)g/L,respectively.Significant Statistical differences were observed in age,gender,history of malignancy(excluding multiple myeloma),and serum albumin were found between the survival and death groups(statistical values:t=4.04,χ^(2)=4.49,χ^(2)=7.51,t=3.85;all P<0.05).AIK 1 stage were 33.33%(21/63)and 64.15%(34/53),2 stage were 36.51%(23/63)and 24.53%(13/34),3 stage were 30.16%(23/63)and 11.32%(6/34)in the renal recovery and non-recovery groupsrespectively.Serum calcium at discharge in the renal recovery and non-recovery groups were(2.50±0.38)mmol/L and(2.70±0.58)mmol/L,respectively,with mean serum calcium levels of(2.60±0.29)mmol/L and(2.78±0.39)mmol/L,and lowest serum calcium levels of(2.28±0.36)mmol/L and(2.50±0.51)mmol/L,respectively.BNP levels were 118(64,283)ng/L and 248(69,1383)ng/L,respectively.Significant differences in AKI stage,serum calcium at discharge,mean serum calcium,lowest serum calcium,and BNP were observed between the two groups(statistical values:χ^(2)=11.84,t=2.26,t=2.75,t=2.73,U=2.62,all P<0.05).Multivariate logistic regression analysis showed that age(OR=1.062,95%CI 1.027-1.098,P<0.001),history of malignancy(excluding multiple myeloma)(OR=3.811,95%CI 1.623-8.951,P=0.002),and serum albumin(OR=0.889,95%CI 0.829-0.953,P=0.001)were independent risk factors for in-hospital mortality of patients;severity of AKI(AKI2 OR=2.984,95%CI 1.281-6.954,P=0.011,AKI3 OR=5.280,95%CI 1.863-14.963,P=0.002)and serum calcium level at discharge(OR=0.813,95%CI 0.666-0.992,P=0.041)were independent risk factors affecting early renal recovery of patients.Conclusion Serum calcium level is not associated with the risk of in-hospital mortality in patients with AKI accompanied by hypercalcemia but is related to the prognosis of early renal recovery.Proactively managing serum calcium,along with treatment of the primary malignancy and correction of hypoalbuminemia can help improve the prognosis of these patients.