老年登革热患者并发急性肾损伤的临床特征分析

Clinical characteristics of acute kidney injury in elderly patients with dengue fever

目的探讨老年登革热患者并发急性肾损伤(acute kidney injury,AKI)的临床特征及其相关危险因素,为老年登革热的临床诊治提供参考。方法选取2013年1月—2019年12月于广州医科大学附属市八医院住院的老年登革热患者,比较AKI组和非AKI组的临床特征,并运用多因素logistic回归分析筛选并发AKI的相关危险因素。结果共纳入老年登革热患者423例,其中并发AKI患者30例(占7.09%)。AKI组年龄为76(68,82)岁,非AKI组为69(63,77)岁,差异有统计学意义(Z=-3.100,P<0.05);AKI组与非AKI组查尔森合并症指数(Chalson's comorbidity index,CCI)评分<3分的分别为19例(占63.33%)、334例(占84.99%),差异有统计学意义(χ^(2)=7.709,P<0.05)。实验室指标中,AKI组与非AKI组的血钾[3.46(3.11,3.79)mmol/L vs.3.28(2.98,3.58)mmol/L]、C反应蛋白水平[6.35(3.78,28.17)mg/L vs.2.50(0.88,5.93)mg/L]、红细胞比容[37.40(33.58,41.00)%vs.39.70(36.60,42.45)%]比较,差异均有统计学意义(Z=2.038、3.866、-2.186,P均<0.05)。AKI组重症登革热病例与非AKI组的重症病例构成[(15例,占50.00%)vs.(21例,占5.34%)]、住院天数[7.5(5,10)d vs.5(4,7)d]比较,差异均有统计学意义(χ^(2)=65.765,Z=-3.802,P均<0.05)。多因素logistic回归分析显示,年龄[OR=1.068,95%CI:(1.020,1.119)]、C反应蛋白水平[OR=1.014,95%CI:(1.004,1.025)]和CCI评分≥3分[OR=2.672,95%CI:(1.176,6.069)]是老年登革热患者并发AKI相关危险因素。结论老年登革热患者AKI发生率较高,且与不良预后相关,较高的年龄、C反应蛋白水平和CCI评分可能会增加AKI的发生风险。提示临床上对于老年登革热患者应尽早发现AKI并积极干预,以改善预后。

Objective To investigate the clinical characteristics and risk factors for elderly patients with dengue fever complicated with acute kidney injury(AKI)for reference for clinical diagnosis and treatment of the elderly patients with dengue fever.Methods Elderly patients with dengue fever treated in Guangzhou Eighth People's Hospital,Guangzhou Medical University,were included from January 2013 to December 2019,and compared for the clinical characteristics of patients in AKI group and non-AKI group.Multivariate logistic regression model was used to analyze the influencing factors for dengue fever complicated with AKI.Results A total of 423 elderly patients with dengue fever were included,of whom 30(7.09%)were complicated with AKI.The age of the patients in the AKI and non AKI group was 76(68,82)years,and 69(63,77)years,respectively.The difference was significant(Z=3.100,P<0.05).The scoring on Chalson's comorbidity index(CCI)less than 3 accounted for 19 cases in the AKI group(63.33%)and 334 cases in the non-AKI group(84.99%),with statistical significance(χ^(2)=7.709,P<0.05).In laboratory indicators,there were statistical significance in blood potassium levels[3.46(3.11,3.79)mmol/L vs.3.28(2.98,3.58)mmol/L],C-reactive protein levels[6.35(3.78,28.17)mg/L vs.2.50(0.88,5.93)mg/L],and hematocrit[37.40(33.58,41.00)%vs.39.70(36.60,42.45)%]between the AKI group and the non AKI group(Z=2.038,3.866,-2.186,respectively,all P<0.05).The distribution of severe cases in the AKI and non-AKI groups[(15 cases,50.00%)vs.(21 cases,5.34%)]and the duration of hospitalization[7.5(5,10)days vs.5(4,7)days]exhibited significant differences(χ^(2)=65.765,Z=-3.802,P<0.05).Multivariate logistic regression analysis revealed that the age[OR=1.068,95%CI:(1.020,1.119)],C-reactive protein levels[OR=1.014,95%CI:(1.004,1.025)],and CCI score≥3 points[OR=2.672,95%CI:(1.176,6.069)]were independent risk factors for elderly dengue fever patients complicated with AKI.Conclusion Elderly dengue fever patients have a high incidence of AKI,which may lead to poor prognosis.The risks of developing AKI can be added in the patients who are older,have elevated CRP levels,and higher CCI scores.Our findings suggest that early detection and active prevention of AKI in elderly dengue fever patients are important in clinical practice to improve the prognosis.