中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2013年
4期
299-304
,共6页
脓毒症%重症监护%急性肾损伤%KDIGO标准
膿毒癥%重癥鑑護%急性腎損傷%KDIGO標準
농독증%중증감호%급성신손상%KDIGO표준
Sepsis%Intensive care%Acute kidney injury%KDIGO criteria
目的 以提高肾脏病整体预后工作组(KDIGO)诊断标准分析重症监护病房(ICU)内脓毒症相关急性肾损伤(AKI)患者的临床特征和预后.方法 应用KDIGO推荐的AKI诊断标准,收集2007年6月-2012年6月江苏省无锡市人民医院ICU收治的符合入选标准的AKI患者资料,回顾性分析脓毒症相关AKI患者的临床特征、预后和影响患者死亡的主要危险因素.结果 在收治的703例AKI患者中,脓毒症相关AKI 395例(56.2％),脓毒症是发生AKI最主要的原因.脓毒症相关AKI患者中,AKI Ⅰ期146例(37.0％),Ⅱ期154例(39.0％),Ⅲ期95例(24.1％).与非脓毒症相关AKI患者比较,脓毒症相关AKI组急性生理与慢性健康评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)更高(25.1 ±4.9比20.5±6.4,12.9±2.6比10.4 ±4.5;P值均＜0.05).两组基础血肌酐值差异无统计学意义[(82.9±22.2)μmol/L比(83.1±30.0)μmol/L,P＞O.05],但ICU期间脓毒症相关AKI组血肌酐更高[(143.5 ±21.6) μmol/L比(96.2 ±15.5) μmol/L,P＜O.05],进展为AKIⅡ期和Ⅲ期的比例更高(63.0％比33.1％,P＜0.05),接受肾脏替代治疗的比例更高(22.3％比6.2％,P＜O.05),而肾功能完全恢复的患者比例更少(74.4％比82.8％,P值均＜0.05).脓毒症相关AKI患者90 d病死率高于非脓毒症相关AKI患者(52.2％比34.1％,P＜0.05).随着KDIGO分期的增加,脓毒症相关AKI患者病死率增加.Logistic回归分析显示APACHEⅡ(OR=5.451,95％ CI:3.095 ～9.416)、SOFA(OR=2.166,95％CI:1.964～4.515)和肾脏替代治疗(OR=4.021,95％ CI:2.975 ～6.324)均是脓毒症相关AKI患者死亡的独立危险因素.结论 脓毒症相关AKI患者全身疾病严重程度高、肾功能差、病死率高.APACHEⅡ、SOFA和肾脏替代治疗是脓毒症相关AKI患者死亡的独立危险因素.
目的 以提高腎髒病整體預後工作組(KDIGO)診斷標準分析重癥鑑護病房(ICU)內膿毒癥相關急性腎損傷(AKI)患者的臨床特徵和預後.方法 應用KDIGO推薦的AKI診斷標準,收集2007年6月-2012年6月江囌省無錫市人民醫院ICU收治的符閤入選標準的AKI患者資料,迴顧性分析膿毒癥相關AKI患者的臨床特徵、預後和影響患者死亡的主要危險因素.結果 在收治的703例AKI患者中,膿毒癥相關AKI 395例(56.2％),膿毒癥是髮生AKI最主要的原因.膿毒癥相關AKI患者中,AKI Ⅰ期146例(37.0％),Ⅱ期154例(39.0％),Ⅲ期95例(24.1％).與非膿毒癥相關AKI患者比較,膿毒癥相關AKI組急性生理與慢性健康評分Ⅱ(APACHEⅡ)、序貫器官衰竭評分(SOFA)更高(25.1 ±4.9比20.5±6.4,12.9±2.6比10.4 ±4.5;P值均＜0.05).兩組基礎血肌酐值差異無統計學意義[(82.9±22.2)μmol/L比(83.1±30.0)μmol/L,P＞O.05],但ICU期間膿毒癥相關AKI組血肌酐更高[(143.5 ±21.6) μmol/L比(96.2 ±15.5) μmol/L,P＜O.05],進展為AKIⅡ期和Ⅲ期的比例更高(63.0％比33.1％,P＜0.05),接受腎髒替代治療的比例更高(22.3％比6.2％,P＜O.05),而腎功能完全恢複的患者比例更少(74.4％比82.8％,P值均＜0.05).膿毒癥相關AKI患者90 d病死率高于非膿毒癥相關AKI患者(52.2％比34.1％,P＜0.05).隨著KDIGO分期的增加,膿毒癥相關AKI患者病死率增加.Logistic迴歸分析顯示APACHEⅡ(OR=5.451,95％ CI:3.095 ～9.416)、SOFA(OR=2.166,95％CI:1.964～4.515)和腎髒替代治療(OR=4.021,95％ CI:2.975 ～6.324)均是膿毒癥相關AKI患者死亡的獨立危險因素.結論 膿毒癥相關AKI患者全身疾病嚴重程度高、腎功能差、病死率高.APACHEⅡ、SOFA和腎髒替代治療是膿毒癥相關AKI患者死亡的獨立危險因素.
목적 이제고신장병정체예후공작조(KDIGO)진단표준분석중증감호병방(ICU)내농독증상관급성신손상(AKI)환자적림상특정화예후.방법 응용KDIGO추천적AKI진단표준,수집2007년6월-2012년6월강소성무석시인민의원ICU수치적부합입선표준적AKI환자자료,회고성분석농독증상관AKI환자적림상특정、예후화영향환자사망적주요위험인소.결과 재수치적703례AKI환자중,농독증상관AKI 395례(56.2％),농독증시발생AKI최주요적원인.농독증상관AKI환자중,AKI Ⅰ기146례(37.0％),Ⅱ기154례(39.0％),Ⅲ기95례(24.1％).여비농독증상관AKI환자비교,농독증상관AKI조급성생리여만성건강평분Ⅱ(APACHEⅡ)、서관기관쇠갈평분(SOFA)경고(25.1 ±4.9비20.5±6.4,12.9±2.6비10.4 ±4.5;P치균＜0.05).량조기출혈기항치차이무통계학의의[(82.9±22.2)μmol/L비(83.1±30.0)μmol/L,P＞O.05],단ICU기간농독증상관AKI조혈기항경고[(143.5 ±21.6) μmol/L비(96.2 ±15.5) μmol/L,P＜O.05],진전위AKIⅡ기화Ⅲ기적비례경고(63.0％비33.1％,P＜0.05),접수신장체대치료적비례경고(22.3％비6.2％,P＜O.05),이신공능완전회복적환자비례경소(74.4％비82.8％,P치균＜0.05).농독증상관AKI환자90 d병사솔고우비농독증상관AKI환자(52.2％비34.1％,P＜0.05).수착KDIGO분기적증가,농독증상관AKI환자병사솔증가.Logistic회귀분석현시APACHEⅡ(OR=5.451,95％ CI:3.095 ～9.416)、SOFA(OR=2.166,95％CI:1.964～4.515)화신장체대치료(OR=4.021,95％ CI:2.975 ～6.324)균시농독증상관AKI환자사망적독립위험인소.결론 농독증상관AKI환자전신질병엄중정도고、신공능차、병사솔고.APACHEⅡ、SOFA화신장체대치료시농독증상관AKI환자사망적독립위험인소.
Objective To evaluate the value of Kidney Disease:Improving Global Outcomes (KDIGO) criteria in investigating clinical feature and prognosis of acute kidney injury (AKI) patients with sepsis in ICU.Methods Clinical data of patients with AKI defined by KDIGO criteria in ICU of Wuxi People's Hospital from June 2007 to June 2012 were collected.Clinical characteristics,prognosis and major risk factors of death of septic AKI patients were retrospectively analyzed.Results Of the enrolled 703 AKI patients,395 (56.2％) were caused by sepsis (septic AKI),which indicated that sepsis mainly contributed to the causes of AKI.For septic AKI stratified by KDIGO classification,146(37.0％) patients belonged to AKI Ⅰ,154(39.0％) to AKI Ⅱ,and 95 (24.1％) to AKI Ⅲ.Compared with the patients with non-septic AKI,septic AKI patients had greater APACHE Ⅱ and SOFA score (25.1 ±4.9 vs 20.5 ±6.4,12.9 ±2.6vs 10.4 ± 4.5 ; all P values ＜ 0.05).Although there was no significant difference in baseline serum creatinine [(82.9 ± 22.2) μmol/L vs (83.1 ± 30.O) μmol/L,P ＞ 0.05] between the two groups,patients with sepsis had higher serum creatinine [(143.5 ± 21.6) μmol/L vs (96.2 ± 15.5) μmol/L; P ＜ 0.05],a higher proportion fulfilled KDIGO categories for both AKI Ⅱ and Ⅲ (63.0％ vs 33.1％ ; P ＜ 0.05),a higher renal replacement therapy (RRT) rate (22.3％ vs 6.2％ ; P ＜ 0.05) and a lower proportion of complete renal recovery(74.4％ vs 82.8％) (all P values ＜ 0.05).The 90-day mortality of septic AKI patients was higher than that of non-septic AKI patients (52.2％ vs 34.1％ ; P ＜ 0.05).Septic AKI,graded by KDIGO,was associated with an increased mortality.Logistic regression analysis showed that APACHE Ⅱ score (OR =5.451,95％ CI:3.095-9.416),SOFA score (OR =2.166,95％ CI:1.964-4.515) and RRT (OR =4.021,95％ CI:2.975-6.324) were independent risk factors for mortality of septic AKI patients.Conclusion Septic AKI patients have a higher burden of illness,worse renal function and higher mortality.APACHE Ⅱ score,SOFA score and RRT are independent risk factors to septic AKI mortality.
