摘要
目的以提高。肾脏病整体预后工作组（KDIGO）诊断标准分析重症监护病房（ICU）内脓毒症相关急性肾损伤（AKI）患者的临床特征和预后。方法应用KDIGO推荐的AKI诊断标准，收集2007年6月_012年6月江苏省无锡市人民医院ICU收治的符合入选标准的AKI患者资料，回顾性分析脓毒症相关AKI患者的临床特征、预后和影响患者死亡的主要危险因素。结果在收治的703例AKI患者中，脓毒症相关AKI395例（56．2％），脓毒症是发生AKI最主要的原因。脓毒症相关AKI患者中，AKII期146例（37．0％），Ⅱ期154例（39．0％），II期95例（24．1％）。与非脓毒症相关AKI患者比较，脓毒症相关AKI组急性生理与慢性健康评分Ⅱ（APACHEⅡ）、序贯器官衰竭评分（SOFA）更高（25．14-4．9比20．5±6．4，12．9±2．6比10．4±4．5；P值均〈0．05）。两组基础血肌酐值差异无统计学意义[（82．94-22．2）Ixmol／L比（83．1±30．0）txmol／L，P〉0．05]，但ICU期间脓毒症相关AKI组血肌酐更高[（143．54-21．6）Ixmol／L比（96．24-15．5）pmlol／L，P〈0．05]，进展为AKIII期和Ⅲ期的比例更高（63．0％比33．1％，P〈0．05），接受肾脏替代治疗的比例更高（22．3％比6．2％，P〈0．05），而肾功能完全恢复的患者比例更少（74．4％比82．8％，P值均〈0．05）。脓毒症相关AKI患者90d病死率高于非脓毒症相关AKI患者（52．2％比34．1％，P〈0．05）。随着KDIGO分期的增加，脓毒症相关AKI患者病死率增加。Logistie回归分析显示APACHEII（OR=5．451，95％CI．3．095—9．416）、SOFA（OR=2．166，95％c，：1．964～4．515）和肾脏替代治疗（OR=4．021，95％CI：2．975～6．324）均是脓毒症相关AKI患者死亡的独立危险因素。结论脓毒症相关AKI患者全身疾病严重程度高、肾功能差、病死率高。APACHE11、SOFA和肾脏替代治疗是脓毒症相关AKI患者死亡的独立危险因素。
Objective To evaluate the value of Kidney Disease： Improving Global Outcomes （KDIGO） criteria in investigating clinical feature and prognosis of acute kidney injury （AKI） patients with sepsis in ICU. Methods Clinical data of patients with AKI defined by KDIGO criteria in ICU of Wuxi People＇s Hospital from June 2007 to June 2012 were collected. Clinical characteristics, prognosis and major risk factors of death of septic AKI patients were retrospectively analyzed. Results Of the enrolled 703 AKI patients, 395 （56. 2% ） were caused by sepsis （septic AKI）, which indicated that sepsis mainly contributed to the causes of AKI. For septic AKI stratified by KDIGO classification, 146（37. 0% ） patients belonged to AKI I , 154（39. 0% ） to AKI lI ,and 95 （24. 1% ） to AK1 ]]I. Compared with the patients with non-septic AKI, septic AKI patients had greater APACHE U and SOFA score （25.1 ±4. 9 vs 20. 5 ±6.4,12. 9 ±2. 6 vs 10.4 ± 4.5 ; all P values 〈 0.05 ） . Although there was no significant difference in baseline serum ereatinine [ （ 82. 9 ± 22. 2） Ixmol/L vs （ 83.1 ± 30. 0 ） p±mol/L, P 〉 O. 051 between the two groups, patients with sepsis had higher serum creatinine [ （ 143.5 ± 21.6 ） Ixmol/L vs （ 96. 2 ± 15.5 ） Ixmol/L; P 〈 0. 05 ], ahigher proportion fulfilled KDIGO categories for both AKI and III （63.0% vs 33.1% ; P 〈 0. 05 ）, a higher renal replacement therapy （RRT） rate （ 22. 3% vs 6. 2% ; P 〈 0. 05 ） and a lower proportion of complete renal recovery（74. 4% vs 82.8% ） （ all P values 〈 0.05 ）. The 90-day mortality of septic AKI patients was higher than that of non-septic AKI patients （52. 2% vs 34. 1% ; P 〈 0.05）. Septic AKI, graded by KDIGO, was associated with an increased mortality. Logistic regression analysis showed that APACHE II score （ OR = 5. 451, 95% CI： 3. 095-9. 416 ）, SOFA score （ OR = 2. 166, 95% CI： 1. 964- 4. 515 ） and RRT （OR =4. 021,95% CI：2. 975-6. 324） were independent risk factors for mortality of septic AKI patients. Conclusion Septic AKI patients have a higher burden of illness, worse renal function and higher mortality. APACHE II score, SOFA score and RRT are independent risk factors to septic AKI
出处
《中华内科杂志》
CAS
CSCD
北大核心
2013年第4期299-304,共6页
Chinese Journal of Internal Medicine
