肿瘤相关性急性肾损伤的发生率及相关危险因素:单中心回顾性研究

Incidence and Risk Factors of Tumor-Associated Acute Kidney Injury:A Single-Center Retrospective Study

目的:分析肿瘤相关性急性肾损伤(acute kidney injury,AKI)的发生情况,并探讨相关危险因素,为早期识别肿瘤相关性AKI高危人群,改善患者预后提供参考依据。方法:以2018年1月1日至2022年12月31日在我院就诊的3432例恶性肿瘤患者作为研究对象,在医院数据管理平台收集研究对象的性别、年龄,基础肝肾功能指标等资料,计算AKI的发生率,并按照是否合并AKI分为病例组和对照组,采用Logistic回归模型分析恶性肿瘤合并AKI的相关危险因素。结果:肿瘤相关性AKI的发生率为4.90%。单因素分析显示:男性AKI的发生率高于女性,共患糖尿病、高血压和既往发生过卒中、心力衰竭的恶性肿瘤患者发生AKI的风险显著增加;血液系统肿瘤、有远处转移和入院时病情危重的患者其AKI的发生率更高;接受手术治疗的恶性肿瘤患者AKI的发生率更高;基础肝肾功能异常,包括ALT≥80 U/L、AST≥70 U/L、TBiL≥20.4μmol/L、SUA>480μmol/L、SCr≥115μmol/L和eGFR≤90 mL·min^(-1)·1.73 m^(-2)患者的AKI发生率更高;低白蛋白血症(album<35 g/L)和贫血的恶性肿瘤患者(hemoglobin<115 g/L)更容易在住院期间出现AKI;此外,各种类型的电解质紊乱均与AKI的发生相关。经多因素Logistic回归分析校正后发现,SCr、eGFR、电解质紊乱、血液系统肿瘤与恶性肿瘤患者合并发生AKI相关,其是恶性肿瘤住院患者发生AKI的独立危险因素(P<0.05)。结论:AKI是恶性肿瘤患者常见且严重的并发症,入院及时监测电解质水平及肾功能变化,及早识别危险因素有助于早期预防和诊断AKI。

Objective:To analyze the occurrence of tumor-associated acute kidney injury(AKI)and explore the risk factors,so as to provide evidence for early identification of tumor-related AKI high-risk groups and improve the prognosis of patients.Methods:3,432 cases of malignant tumor patients in our hospital from January 1,2018 to December 31,2022 were selected as the research objects.Gender,age,basic liver and kidney function indexes and other data of the research objects were collected in the hospital data management platform,and the incidence of AKI were calculated.According to the presence of AKI,the patients were assigned to the case group and the control group.Logistic regression model was used to analyze the risk factors of tumor-associated AKI.Results:The incidence of tumor-associated AKI was 4.90%.Univariate analysis showed that the incidence of AKI in male was higher than that in female,and the risk of AKI in patients with diabetes,hypertension,stroke and heart failure significantly increased;the incidence of AKI in patients with hematological tumors,distant metastasis and critical condition at admission was higher;the incidence of AKI in patients with malignant tumor receiving surgical treatment was higher;the incidence of AKI was higher in patients with renal dysfunction[alanine aminotransferase≥80 U/L,aspartic transaminase≥70μ/L,total bilirubin≥20.4μmol/L,serum uric acid>480μmol/L,serum creatinine(SCr)≥115μmol/L and estimated glomerular filtration rate(eGFR)≥90 mL·min^(-1)·1.73 m^(-2)];hypoalbuminemia(albumin<35 g/L)and anemia(hemoglobin<115 g/L)patients with malignant tumor were more likely to develop AKI during hospitalization;in addition,various types of electrolyte disorders were associated with AKI.Multivariate logistic regression analysis found that SCr,eGFR,electrolyte disorders and hematological tumor were associated with AKI in patients with malignant tumor,and they were independent risk factors for AKI in patients with malignant tumor(P<0.05).Conclusion:AKI is a common and serious complication in patients with malignant tumor.Timely monitoring of electrolyte level and renal functions and early identification of risk factors are helpful to early prevention and diagnosis of AKI.