摘要
目的探讨影响接受肾脏替代治疗急性肾损伤(AKI)患者死亡的危险因素及其在AKI患者预后中的预测价值。方法选择2020年1月—2021年12月首都医科大学附属北京康复医院老年重症监护病房收治的行连续性肾脏替代治疗(CRRT)老年AKI患者116例作为研究对象。根据患者入重症监护病房28 d预后分为存活组和病死组,比较2组患者资料。采用多因素Logistic回归分析影响AKI患者28 d死亡相关的危险因素,受试者工作特征曲线(ROC)评估其预测价值。结果最终有80例AKI患者符合入组标准,其中生存组32例,病死组48例,其病死率为60.0%。与生存组比较,病死组AKI患者年龄更大,急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、撤CRRT前中心静脉压(CVP)更高,差异均有统计学意义(t/P=2.832/0.006、3.374//0.001、3.159/0.002、4.184/<0.001)。多因素Logistic回归分析结果显示,年龄大、APACHEⅡ评分高、SOFA评分高、撤CRRT前CVP高是导致AKI患者28 d死亡的独立危险因素[OR(95%CI)=1.103(1.005~1.210)、1.117(1.042~1.197)、1.232(0.971~1.562)、2.590(1.379~4.862)]。ROC曲线分析显示,4种导致重症监护病房AKI患者死亡的危险因素均能够预测患者28 d预后,以撤CRRT前CVP的ROC曲线下面积(AUC)最大(AUC=0.829),当最佳临界值为7.5 mmHg时,敏感度为0.813,特异度为0.719,其他主要临床指标的AUC均<0.8。结论接受CRRT治疗AKI患者病死率很高,高龄、撤CRRT前高CVP、APACHEⅡ评分高、SOFA评分高均是患者死亡的危险因素,4种预测指标均对AKI患者的不良预后具有一定预测价值。
Objective To explore the risk factors for mortality in patients with acute kidney injury(AKI)receiving renal replacement therapy and their predictive value in the prognosis of AKI patients.Methods One hundred and sixteen eld⁃erly AKI patients who underwent continuous renal replacement therapy(CRRT)in the intensive care unit of Beijing Rehabili⁃tation Hospital affiliated with Capital Medical University from January 2020 to December 2021 were selected as the study subjects.According to the 28 day prognosis of patients admitted to the intensive care unit,they were divided into survival group and mortality group,and the data of the two groups of patients were compared.Multivariate logistic regression analysis was used to assess the risk factors associated with 28 day mortality in AKI patients,and the predictive value was evaluated using the receiver operating characteristic curve(ROC).Results During the study period,there were a total of 116 AKI pa⁃tients.According to the exclusion criteria,80 of them met the inclusion criteria,including 32 in the survival group and 48 in the mortality group,with a mortality rate of 60.0%.Compared with the survival group,AKI patients in the death group were ol⁃der,with higher acute physiology and chronic health status scoreⅡ(APACHEⅡ),sequential organ failure score(SOFA),and central venous pressure(CVP)before CRRT withdrawal,with statistically significant differences(t/P=2.832/0.006,3.374/0.001,3.159/0.002,4.184/<0.001).The results of multivariate Logistic regression analysis showed that older age,higher APACHEⅡscore,higher SOFA score,and higher CVP before CRRT withdrawal were independent risk factors for 28 day mortality in AKI patients[OR(95%CI)=1.103(1.005-1.210),1.117(1.042-1.197),1.232(0.971-1.562),2.590(1.379-4.862)].ROC curve analysis showed that all four risk factors leading to death in AKI patients in the intensive care unit were able to predict the patient's 28 day prognosis,with the area under the ROC curve(AUC)of CVP before CRRT withdrawal being the largest(A
作者
杨凯
陈珊珊
马小民
刘自双
Yang Kai;Chen Shanshan;Ma Xiaomin;Liu Zishuang(The Geriatric Intensive Care Unit,the Beijing Rehabilitation Hospi-tal of Capital Medical University,Beijing 100144,China)
出处
《疑难病杂志》
CAS
2023年第6期625-629,共5页
Chinese Journal of Difficult and Complicated Cases
关键词
肾损伤
急性
连续性肾脏替代疗
危险因素
中心静脉压
预测价值
老年人
Kidney injury,acute
Continuous renal replacement therapy
Risk factors
Central venous pressure
Pre⁃dictive value
Elderly
