摘要
目的评估肿瘤术后危重症患者发生急性肾损伤(AKI)接受持续肾脏替代治疗(CRRT)后早期肾功能恢复的因素影响分析。方法收集86例术后发生AKI需要行CRRT治疗危重症肿瘤患者的临床资料,记录出院时患者的肾功能恢复情况,分为恢复组和未恢复组,分析与比较两组患者的临床资料。影响需要行CRRT治疗的AKI的肿瘤患者肾功能恢复的影响因素采用Logistic回归分析;肾功能累计恢复率的比较采用Log-rank检验;采用受试者工作特征(ROC)曲线和曲线下面积(AUC)评估独立危险因素预测肾功能院内恢复的效能。结果共38例患者肾功能在出院前获得了恢复,48例患者肾功能未恢复。Logistic回归分析结果显示,入室时简化急性生理学评分Ⅲ(SAPSⅢ)评分≥65分、CRRT开始24 h内尿量<100 ml是影响术后AKI-3级且需要行CRRT的危重症肿瘤患者院内肾功恢复的独立危险因素(P<0.05)。入室时SAPSⅢ评分<65分患者的28天肾功能恢复率明显高于入室时SAPSⅢ评分≥65分的患者,CRRT开始24 h内尿量<100 ml患者的28天肾功能恢复率明显低于CRRT开始24 h内尿量≥100 ml的患者,差异均有统计学意义(P<0.01);入室时SAPSⅢ评分<65分、CRRT开始24 h内尿量≥100 ml预测患者院内肾功能恢复的AUC分别为0.725 (95%CI:0.615~0.835)、0.908(95%CI:0.845~0.971)。结论患者早期肾功能恢复率较低,入室时病情危重、CRRT开始后24小时内尿量少的肿瘤术后AKI-3级且需要行CRRT的危重症患者早期肾功能恢复率低,可以作为预测早期肾功能恢复的因素,入院时出现远处转移并不影响早期肾功能的恢复。
Objective To evaluate the factors associated with the short-term recovery of renal function for critically ill cancer patients with postoperative acute renal injury(AKI) treated with continuous renal replacement therapy(CRRT).Method The clinical data from 86 critically ill cancer patients with postoperative AKI which required CRRT were collected,the recovery of renal function were recorded for all patients at the time of discharge,and they were divided into recovered renal function group and non-recovered group to analyze and compare the clinical data.Logistic regression analysis was performed to identify independent risk factors for renal function recovery in cancer patients with AKI necessitating CRRT;renal function recovery rate was estimated by Log-rank test.ROC curves were plotted and AUC was calculated to assess the performance of independent risk factors in predicting renal function recovery in hospital.Result A total of 38 patients achieved renal recovery before hospital discharge,while the remaining 48 patients did not.Logistic regression analysis revealed that,simplified acute physiology score □(SAPS □)≥65 at ICU admission,urine output within the first 24 h of CRRT <100 ml were independent risk factors influencing the renal recovery of critically ill cancer patients with postoperative AKI grade 3 and required CRRT in hospital(P<0.05).SAPS Ⅲ <65 at ICU admission was associated with an increased 28-day renal function recovery rate compared to SAPS Ⅲ≥ 65,besides,the 28-day renal recovery rate in patients with urine output within the first 24 h of CRRT <100 ml was significantly lower compared to those with urine output≥ 100 ml in the initial 24 h of CRRT(P<0.01).SAPS Ⅲ <65 at ICU admission and urine output≥ 100 ml within first 24 h of CRRT showed an AUC of 0.725(95%CI:0.615-0.835) and 0.908(95%CI:0.845-0.971) in predicting the renal recovery of critically ill cancer patients in hospital.Conclusion For critically ill cancer patients with postoperative AKI grade 3 and needed CRRT,reduced ear
作者
袁振南
王海军
曲世宁
黄初林
王浩
张昊
杨全会
邢学忠
YUAN Zhennan;WANG Haijun;QU Shining;HUANG Chulin;WANG Hao;ZHANG Hao;YANG Quanhui;XING Xuezhong(Department of Intensive Care Unit,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)
出处
《癌症进展》
2020年第13期1315-1319,1348,共6页
Oncology Progress
关键词
肿瘤
术后
急性肾损伤
持续肾脏替代治疗
肾功能恢复
cancer
postoperative
acute renal injury
continuous renal replacement therapy
renal function recovery
