摘要
目的探讨社区获得性肺炎(CAP)住院患者中严重急性肾损伤(sAKI)的发生率、时间、危险因素及其对临床结局的影响.方法回顾性收集2013年1月1日至2015年12月31日在北京、山东和云南5家教学医院住院的所有CAP患者病例资料.Cox比例风险模型探讨sAKI对CAP患者临床结局[30 d病死率、入住重症监护单元(ICU)、有创机械通气和需要使用血管活性药物]的影响.单因素分析和Logistic回归分析研究CAP患者发生sAKI的独立危险因素.结果共有3561例CAP患者纳入最后分析,sAKI发生率为0.7%(26/3561),从发生至入院间隔时间中位值2.0d.经过年龄、性别、基础病和PSI分级/CURB-65评分调整的Cox比例风险模型显示,发生sAKI与CAP患者30 d死亡[风险比(HR)16.144,95%可信区间(CI)3.549~43.232,P<0.001]、入住ICU(HR9.931,95%CI2.311~23.167,P=0.011)、有创机械通气(HR9.494,95%CI2.122~48.483,P=0.003)、需要使用血管活性药物(HR5.547,95%CI1.735~17.731,P=0.004)风险增高相关.Logistic回归分析证实:年龄[比值比(OR)1.095,95%CI1.017~1.180,P=0.017]、慢性肾病(OR 11.073,95%CI2.939~41.715,P<0.001)、意识障碍(OR6.468,95%CI1.551~26.980,P=0.010)、血白蛋白<30 g/L(OR6.469,95%CI1.807~23.161,P=0.011)和动脉血乳酸>2 mmo]/L(OR 6.922,95%CI1.993~24.043,P=0.002)是CAP住院患者发生sAKI的独立危险因素.结论sAKI使CAP住院患者临床结局恶化.年龄、慢性肾病、意识障碍、血白蛋白<30 g/L和动脉血乳酸>2 mmol/L等危险因素有助于临床医生早期识别CAP患者发生sAKI的风险,以采取防治措施降低CAP的病死率.
Objective To investigate the prevelance,timing,risk factors and impact on the clinical outcomes of severe acute kidney injury(sAKI)in the patients hospitalized with community-acquired pneumonia(CAP).Methods Data of the patients hospitalized with CAP in five teaching hospitals from Beijing,Shandong and Yunnan provinces between 1 January 2013 and 31 December 2015 was collected retrospectively.A Cox proportional hazard regression model was used to evaluate the impact of sAKI on the clinical outcomes[30-day mortality,admission to intensive care unit(ICU),invasive ventilation and needing vasopressor use].Univariate and multivariate Logistic regression analysis were performed to explore the risk factors for sAKI in CAP patients.Results 3561 CAP patients were entered into final analysis,and 0.7%(26/3561)patients developed sAKI with the median duration 2.0 days from onset to admission.Cox proportional hazard model by adjusting age,sex,morbidities and PSI/CURB-65 score showed sAKI was associated with increased risks of 30-day mortality[hazard ratio(HR)16.144,95%C/3.549-43.232,P<0.001],ICU admission(HR 9.93\,95%C/2.311-23.167,P=0.011),invasive ventilation(HR 9.494,95%Cl 2.122-48.483,P=0.003)and needing vasopressor use(HR 5.547,95%Cl 1.735-17.731,P=0.004)in CAP patients.Logistic regression analysis confirmed age[odd ratio(OR)1.095,95%Cl 1.017-1.180,P=0.017],preexisting chronic kidney(OR 11.073,95%Cl 2.939-41.715,P<0.001),confusion(OR 6.468,95%Cl 1.551-26.980,P=0.010),blood albumin<30 g/L(OR 6.469,95%Cl 1.807-23.161,P=0.011)and arterial lactate>2 mmol/L at admission(OR 6.922,95%Cl 1.993-24.043,P=0.002)were independent risk factors for sAKI in CAP patients.Conclusion sAKI worsen the clinical outcomes of CAP patients.The risk factors will help clinicians to identify the CAP patients with high risk of sAKI early,and take prevention to reduce the mortality.
作者
陈亮
韩秀迪
李艳丽
张春晓
邢西迁
Chen Liang;Han Xiu-di;Li Yan-li;Zhang Chun-xiao;Xing Xi-qian(Department of Infectious Disease,Beijing Jishuitan Hospital,Beijing 100096,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2020年第4期312-318,共7页
Chinese Journal of Critical Care Medicine
基金
国家自然科学基金(81760015)。
