摘要
目的探讨老年急性呼吸窘迫综合征(ARDS)患者急性肾损伤(AKI)的发生、危险因素及预后。方法回顾性分析2016年7月至2019年7月在连云港市第二人民医院呼吸内科、急诊及老年科诊治的发生ARDS老年患者的临床资料,根据改善全球肾脏病预后组织(KDIGO)诊断标准分为AKI组和无AKl组,比较两组患者临床指标差异。采用二元Logistic回归分析其相关危险因素,采用Kaplan-Meier曲线分析不同分期AKI对ARDS患者预后的影响,COX比例风险模型分析影响ARDS患者预后不良危险因素。结果共纳入432例ARDS老年患者,年龄(74.7±8.8)岁,其中129例(29.9%)发生AKI。AKI组与无AKI组单因素分析发现AKI组年龄偏高,合并高血压史、糖尿病史、房颤病史比例高,意识障碍、行机械通气发生率高,平均动脉压偏低(均P<0.05)。ARDS中-重度患者AKI发生率升高(P<0.001)。AKI组基础肌酐、天冬氨酸氨基转移酶(AST)、N末端B型利钠肽原(NT-pro-BNP)水平较高(均P<0.01),炎症指标中性粒/淋巴细胞比值(NLR)(P=0.003)及D-2聚体(P<0.001)、超敏C反应蛋白(hsCRP)(P=0.040)升高明显。AKI组尿蛋白(P<0.001)、低射血分数(P=0.040),胸片或CT检查示胸腔积液(P=0.003)阳性率升高。Logistic回归分析提示高血压(OR:1.789,95%CI:1.105~2.894,P=0.018)、糖尿病(OR:1.976,95%CI:1.076~3.628,P=0.028)、意识障碍(OR:2.531,95%CI:1.203~5.251,P=0.014)、机械通气(OR:3.421,95%CI:1.521~7.694,P=0.003)、基础肌酐(OR:1.014,95%CI:1.002~1.027,P=0.024)、AST>40 U/L(OR:2.495,95%CI:1.431~4.348,P=0.001)及NLR(OR:1.015,95%CI:1.001~1.029,P=0.042)是ARDS-AKI独立风险因素。Kaplan-Meier生存曲线显示不同AKI分期对预后影响总体比较差异有统计学意义(χ^(2)=19.790,P<0.001);组间比较显示,与无AKI组比较,AKI(1期)患者预后不良差异无明显统计学意义(χ^(2)=2.188,P=0.139)。与无AKI组、AKI(1期)比较,AKI(2-3期)患者预后不良风险增加(分别为χ^(2)=18.268,P<0.001;χ^(2)=6.347,P=0.012)。多�
Objective To investigate the incidence,risk factors and prognosis of acute renal injury(AKI)in elderly patients with respiratory distress syndrome(ARDS).Methods The elderly patients with ARDS treated in the Department of Respiratory Medicine,Emergency Department and Geriatrics of the Second People's Hospital of Lianyungang from July 2016 to July 2019 were divided into AKI group and non-AKl group according to KDIGO diagnostic criteria.The clinical data and the differences were compared and analyzed between the two groups.Binary Logistic regression was used to analyze Risk factors for AKI.Kaplan-Meier cure was used to analyze the influence of different stages of AKI on the prognosis of ARDS patients.The Cox proportional hazards model was used to analysis risk factors for AKI and ARDS on elderly patients'prognosis.Results A total of 432 elderly patients with ARDS were enrolled in the study,in which the mean age was 74.7±8.8 years,and AKI occurred in 129 cases(29.9%).Compared with non-AKI group,AKI group showed older age,and higher proportion of the incidences of hypertension,diabetes,atrial fibrillation,consciousness disturbance,mechanical ventilation and a low mean arterial pressure(all P<0.05).The incidence of AKI was increased significantly in patients with moderate to severe ARDS(P<0.001).The levels of basal creatinine,AST and NT-proBNP were significantly higher in AKI Group than in non-AKI Group(P=0.001,P<0.001,P<0.001).AKI Group patients had the more elevated inflammatory marker level of neutrophil/lymphocyte ratio(NLR)(P=0.003)and D-dimer(P<0.001),and the level of high-sensitivity c-reactive protein(hsCRP)(P=0.040).AKI group showed the increased incidence of urine protein(P<0.001),low ejection fraction(P=0.040),and positive rate of pleural effusion(P=0.003).Logistic Regression analysis showed the following independent risk factors for the development of ARDS-associated AKI,included hypertension(OR:1.789,95%,CI:1.105-2.894,P=0.018),diabetes(OR:1.976,95%CI:1.076-3.628,P=0.028),consciousness disturbance(OR:2.53
作者
韩红
刘张波
何传梅
李慧
Han Hong;Liu Zhangbo;He Chuanmei;Li Hui(Department of Nephrology,The Second People's Hospital of Lianyungang City 222006)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2021年第10期1280-1285,共6页
Chinese Journal of Geriatrics
关键词
急性呼吸窘迫综合征
急性肾损伤
危险因素
预后
Acute respiratory distress syndrome
Acute kidney injury
Risk factors
Prognosis
