新生儿败血症合并急性肾损伤临床特征分析

Clinical characteristics of neonatal sepsis with acute kidney injury

目的:分析新生儿败血症急性肾损伤(AKI)的临床特征。方法:收集2017年1月—2022年12月入住武汉大学中南医院确诊为新生儿败血症患儿资料,分为AKI组及非AKI组,分析两组患儿的临床特征及死亡危险因素。结果:新生儿败血症AKI发生率为43.8%。与非AKI组比较,AKI组胎龄小、出生体质量低,早发型败血症、革兰阴性菌感染、窒息史、休克、母亲妊娠期高血压疾病、胎膜早破发生率高,差异均有统计学意义(P<0.05);住院时间(d)长[14(8, 40) vs 7(5, 9)]及死亡率高(17.4%vs 0.0%)(P<0.01)。二分类Logistic回归分析显示窒息史(OR=34.793,95%CI:15.188~69.402,P=0.012)和严重AKI(AKI 2~3期)(OR=18.471,95%CI:1.932~50.141,P=0.014)是新生儿败血症死亡的独立危险因素。结论:新生儿败血症容易合并AKI,AKI患儿住院时间长、死亡率高。

Objective To analyze the clinical characteristics of neonatal sepsis with acute kidney injury(AKI).Methods The patients diagnosed with neonatal sepsis admitted to Zhongnan Hospital of Wuhan University from January 2017 to December 2022 were divided into AKI group and non‑AKI group.The clinical characteristics and mortality risk factors of the two groups were analyzed.Results The incidence of AKI was 43.8%among the neonatal sepsis.Compared with the non‑AKI group,the AKI group had smaller gestational age,lower birth weight,higher incidence of early‑onset sepsis,Gram⁃negative bacterial infection,asphyxia,shock,maternal hypertensive disorder,and premature rupture of membrane(P<0.05).The hospitalization time was longer(14(8,40)d vs 7(5,9)d,P<0.01),and the mortality rate was higher(17.4%vs 0.0%,P<0.01).Logistic analysis showed that asphyxia(OR=34.793,95%CI:15.188‑69.402,P=0.012)and severe AKI(AKI stage 2‑3)(OR=18.471,95%CI:1.932‑50.141,P=0.014)were independent risk factors of neonatal sepsis mortality.Conclusion Neonatal sepsis is easy to be complicated with AKI,and AKI children have longer hospital stay and higher mortality.