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潘思梦, 姚瑶, 林世龙, 等. 脓毒症急性肾损伤患者早期肾功能恢复的影响因素分析[J]. 中国临床医学, 2024, 31(3): 451-456. DOI: 10.12025/j.issn.1008-6358.2024.20240401
引用本文: 潘思梦, 姚瑶, 林世龙, 等. 脓毒症急性肾损伤患者早期肾功能恢复的影响因素分析[J]. 中国临床医学, 2024, 31(3): 451-456. DOI: 10.12025/j.issn.1008-6358.2024.20240401
PAN Simeng, YAO Yao, LIN Shilong, et al. Analysis of influence factors of early renal function recovery in patients with sepsis-associated acute kidney injury[J]. Chinese Journal of Clinical Medicine, 2024, 31(3): 451-456. DOI: 10.12025/j.issn.1008-6358.2024.20240401
Citation: PAN Simeng, YAO Yao, LIN Shilong, et al. Analysis of influence factors of early renal function recovery in patients with sepsis-associated acute kidney injury[J]. Chinese Journal of Clinical Medicine, 2024, 31(3): 451-456. DOI: 10.12025/j.issn.1008-6358.2024.20240401

脓毒症急性肾损伤患者早期肾功能恢复的影响因素分析

Analysis of influence factors of early renal function recovery in patients with sepsis-associated acute kidney injury

  • 摘要:
    目的 分析脓毒症诱导的急性肾损伤(sepsis-associated acute kidney injury, SA-AKI)患者肾功能早期恢复的影响因素。
    方法 回顾性分析2021年1月至2022年12月在复旦大学附属中山医院重症医学科治疗的86例同时符合脓毒症3.0诊断标准和AKI诊断标准的SA-AKI患者。根据是否在发病后7 d内恢复肾功能,将患者分为恢复组和未恢复组。比较两组患者的临床资料和实验室检查结果。采用单因素和多因素logistic回归分析评估影响SA-AKI患者肾功能恢复的危险因素,使用ROC曲线评估各因素对SA-AKI早期肾功能恢复的预测价值。
    结果 SA-AKI患者肾功能恢复37例(43.02%)。与恢复组相比,未恢复组患者肾脏替代治疗率、住院死亡率和入院后28 d死亡率均更高(P<0.001)。多因素logistic回归分析显示,年龄、APACHE Ⅱ评分、尿量、尿中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin, NGAL)、去甲肾上腺素剂量是影响SA-AKI患者肾功能恢复的独立相关因素(P<0.05),回归模型logit(P)=﹣4.091+0.001×尿NGAL-0.001×尿量+0.040×年龄+0.073×APACHEⅡ评分+1.906×去甲肾上腺素剂量。该模型预测SA-AKI早期肾功能恢复的AUC为0.823,灵敏度为73.5%、特异度为81.1%。
    结论 年龄、APACHE Ⅱ评分、尿量、尿NGAL、去甲肾上腺素剂量影响SA-AKI患者肾功能早期恢复,可联合用于评估SA-AKI患者早期肾功能能否恢复。

     

    Abstract:
    Objective To analyze the factors influencing the early recovery of renal function in patients with sepsis-associated acute kidney injury (SA-AKI).
    Methods A retrospective analysis was conducted on 86 SA-AKI patients treated in the Intensive Care Unit at Zhongshan Hospital, Fudan University from January 2021 to December 2022, who met both the Sepsis 3.0 diagnostic criteria and the AKI diagnostic standards. Patients were divided into a recovery group and a non-recovery group based on whether their renal function recovered within 7 days after AKI onset. Clinical data and laboratory tests of patients were compared between the two groups. Univariate and multivariate logistic analyses were used to identify risk factors affecting renal function recovery in SA-AKI patients, and ROC curve was utilized to evaluate the predictive value of these factors for early renal function recovery in SA-AKI patients.
    Results The renal function of 37 (43.02%) patients recoveried. Compared with the recovery group, the renal replacement therapy rate, in-hospital mortality and 28-day mortality of patients in the non-recovery group were higher (P<0.001). The multivariate logistic analysis showed that age, APACHE Ⅱ score, urine output, urine neutrophil gelatinase-associated lipocalin (NGAL), and norepinephrine dose were independent related factors affecting renal function recovery in SA-AKI patients (P<0.05). The final model logit(P)=﹣4.091+0.001×urine NGAL-0.001×urine volume+0.040×age+0.073×APACHEⅡscore+1.906×norepinephrine dose. The AUC of model predicting early SA-AKI recovery was 0.823, with 73.5% of sensitivity, and 81.1% of specificity.
    Conclusions In SA-AKI patients, age, APACHE Ⅱscore, urine output, urine NGAL, and the dose of norepinephrine independently affect early renal function recovery, and the combined assessment of these indicators has predictive value for the early renal recovery in these patients.

     

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