El-Shahawy M A, Agbing L U, Badillo E
Department of Medicine, University of Southern California School of Medicine, Los Angeles 90033, USA.
Int Urol Nephrol. 2000;32(2):185-91. doi: 10.1023/a:1007177130883.
The outcome of patients with acute renal failure (ARF) due to acute tubular necrosis (ATN) was evaluated in this study. Two hundred and twenty-two patients with a mean age of 55.1+/-17.7 years (range 19-97 years; male 153, female 69) who developed ATN in the period from July 1991 through January 1997 were studied. Patients were divided into four groups according to their APACHE II scores at the time of the diagnosis of ATN. Group I included patients with an APACHE II score of 14 or less (n = 70), Group II with a score of 15-18 (n = 52), Group III with a score of 19-23 (n = 58), and group IV with a score of 24 or above (n = 42). The mean APACHE II score for each of the four study groups was 11+/-0.4, 16+/-0.2, 20+/-0.2, and 29+/-0.7, respectively. Patient survival was evaluated by the Kaplan-Meier analysis with censorship at 12 months. Survival rates at 180 days were 67%, 47%, 39%, and zero%, for group I through IV respectively, chi2 = 27.99, p < 0.0001, with a median survival of >365, 120, 31, and 11 days, for groups I through IV, respectively. For patients with oliguria (n = 88) survival at 180 days was 23% vs. 58% for patients without oliguria (n = 134), p < 0.0001, median survival 13 vs. 364 d. Six months survival of those who required dialysis (n = 79) was 25% vs. 58% for those whom dialysis was not needed (n = 143), p = 0.001, median survival 15 vs. 364 d, respectively. In patients with sepsis (n = 58), 6 months survival was 35% vs. 50% for those without sepsis (n = 164), p = 0.013, median survival 14 vs. 169 d. In patients who required mechanical ventilation (n = 72), 6 months survival was 17% vs. 62% for those who did not need respiratory support (n = 150), p = 0.0001, median survival 13 vs. > 365 d, respectively. Finally, 6 months survival in patients with one (kidney only), two, three, and four organ failure was 76, 30, 11, and zero percent, respectively, p = 0.0001, median survival >365, 16, 11, and 12 days, respectively. We conclude that the use of the APACHE II score for the stratification of the severity of illness could be of clinical utility in predicting mortality in patients with ATN. Other predictors of poor prognosis include the need for dialysis, the presence of oliguria, the need for mechanical ventilation, the presence of sepsis, and the number of failed organs.
本研究评估了因急性肾小管坏死（ATN）导致急性肾衰竭（ARF）患者的预后情况。研究对象为1991年7月至1997年1月期间发生ATN的222例患者，平均年龄55.1±17.7岁（范围19 - 97岁；男性153例，女性69例）。根据ATN诊断时的急性生理与慢性健康状况评分系统（APACHE II）得分，将患者分为四组。第一组包括APACHE II评分为14分及以下的患者（n = 70），第二组评分为15 - 18分（n = 52），第三组评分为19 - 23分（n = 58），第四组评分为24分及以上（n = 42）。四个研究组的平均APACHE II评分分别为11±0.4、16±0.2、20±0.2和29±0.7。采用Kaplan - Meier分析评估患者生存情况，以12个月为截尾时间。第一组至第四组180天的生存率分别为67%、47%、39%和0%，χ2 = 27.99，p < 0.0001，第一组至第四组的中位生存期分别>365天、120天、31天和11天。少尿患者（n = 88）180天的生存率为23%，无少尿患者（n = 134）为58%，p < 0.0001，中位生存期分别为13天和364天。需要透析的患者（n = 79）6个月的生存率为25%，不需要透析的患者（n = 143）为58%，p = 0.001，中位生存期分别为15天和364天。患有脓毒症的患者（n = 58）6个月的生存率为35%，无脓毒症的患者（n = 164）为50%，p = 0.013，中位生存期分别为14天和169天。需要机械通气的患者（n = 72）6个月的生存率为17%，不需要呼吸支持的患者（n = 150）为62%，p = 0.0001，中位生存期分别为13天和>365天。最后，单一器官（仅肾脏）、两个、三个和四个器官功能衰竭患者6个月的生存率分别为76%、30%、11%和0%，p = 0.0001，中位生存期分别>365天、16天、11天和12天。我们得出结论，使用APACHE II评分对疾病严重程度进行分层可能在预测ATN患者死亡率方面具有临床实用性。其他预后不良的预测因素包括需要透析、少尿的存在、需要机械通气、脓毒症的存在以及功能衰竭器官的数量。
