摘要
目的探讨连续性肾脏替代治疗(CRRT)老年脓毒症相关急性肾损伤(S-AKI)的影响因素。方法回顾性分析2018年1月至2022年12月江宁医院收治的118例老年S-AKI患者的临床资料,根据是否采用CRRT治疗分为CRRT组(56例)和非CRRT组(62例),比较两组患者预后情况,采用Logistic回归分析影响因素和构建预测模型。结果两组患者年龄、尿素氮、血肌酐、AKI分期、中性粒细胞明胶酶相关脂质运载蛋白(NAGL)、血钾、铁蛋白、降钙素原、C-反应蛋白、凝血酶原时间、乳酸水平、SOFA评分、氧分压水平及预后情况比较,差异有统计学意义(P<0.05)。单因素分析显示年龄、尿素氮、血肌酐、AKI分期、NAGL、铁蛋白、降钙素原、C-反应蛋白、SOFA评分、乳酸是老年S-AKI选择CRRT的影响因素(P<0.05);多因素Logistic回归分析显示年龄(OR=1.139,95%CI:1.025~1.265)、尿素氮(OR=1.196,95%CI:1.012~1.414)、AKI分期(OR=63.332,95%CI:10.158~394.85)、铁蛋白(OR=1.074,95%CI:1.014~1.138)、乳酸(OR=4.685,95%CI:1.691~12.981)是其独立影响因素。基于上述5项独立影响因素构建预测模型,ROC曲线下面积为0.954(95%CI:0.918~0.990)。结论AKI3期、年龄、尿素氮、铁蛋白及乳酸较高是老年S-AKI患者选择连续性肾脏替代治疗的临床指征,有利于降低患者短期死亡率,可结合预测模型做好预警处理。
Objective To investigate the influencing factors of sepsis-associated acute kidney injury(S-AKI)in elderly patients with continuous renal replacement therapy(CRRT).Methods The clinical data of 118 elderly patients with S-AKI admitted to Jiangning Hospital from January 2018 to December 2022 were retrospectively analyzed.According to whether they were treated with CRRT,they were divided into the CRRT group(56 cases)and the non-CRRT group(62 cases).Logistic regression was used to analyze the influencing factors and construct the prediction model.Results There were significant differences in age,blood urea nitrogen,serum creatinine,AKI stage,neutrophil gelatinase-associated lipid carrier protein(NAGL),serum potassium,f erritin,procalcitonin,C-reactive protein,prothrombin time,lactate level,SOFA score,oxygen partial pressure and prognosis between the two groups(P<0.05).Univariate analysis showed that age,urea nitrogen,serum creatinine,AKI stage,NAGL,ferritin,procalcitonin,C-reactive protein,SOFA score and lactic acid were the influencing factors for CRRT in elderly patients with S-AKI(P<0.05).Multivariate Logistic regression analysis showed that age(OR=1.139,95%CI:1.025~1.265),urea nitrogen(OR=1.196,95%CI:1.012~1.414),AKI stage(OR=63.332,95%CI:10.158~394.85),ferritin(OR=1.074,95%CI:1.014~1.138)and lactic acid(OR=4.685,95%CI:1.691~12.981)were independent influencing factors.The area under the ROC curve was 0.954(95%CI:0.918~0.990).Conclusion AKI stage 3,age,higher levels of urea nitrogen,ferritin and lactic acid are the clinical indications for CRRT in elderly patients with S-AKI,which is beneficial to reduce the short-term mortality.Early warning can be taken in combination with the prediction model.
出处
《浙江临床医学》
2024年第12期1768-1770,1773,共4页
Zhejiang Clinical Medical Journal
基金
南京医科大学康达学院科研发展基金一般项目(KD2023KYJJ259)。
