Franzen Daniel, Rupprecht Cornelia, Hauri Dimitri, Bleisch Jorg A, Staubli Max, Puhan Milo A
Medical Intensive Care Unit, Department of Internal Medicine, University Hospital of Zurich, Switzerland.
Int J Artif Organs. 2010 Jan;33(1):15-21.
Despite advances in the management of critically ill patients with acute kidney injury (AKI), the prognosis is poor. The evidence base on risk factors for poor outcomes in these patients is scarce. Our aim was to identify predictors of outcome in AKI patients undergoing intermittent hemodialysis (IHD).
We retrospectively analyzed patient records from consecutive, critically ill patients with AKI treated with IHD in one teaching secondary care hospital from 2002 to 2006. We used multivariate Cox proportional hazard regression analysis to identify predictors of mortality, hemodynamical instability during hemodialysis and failing renal recovery.
Totally, we included 39 patients with a mean APACHE II score of 20.1 (SD 7.5) who had an average of 5.1 +/- 4.8 hemodialysis sessions. All-cause mortality was 35.9% (14/39 patients). In multivariate analysis, pre-existing cardiac co-morbidity (HR 1.92 [0.58-6.47]), metabolic acidosis (2.40 [0-74-7.74]) and presence of ARDS (1.83 [0.52-6.46]) were the strongest predictors. 7 patients (18%) sustained new hemodynamic instability during hemodialysis, for which ARDS (6.42 [0.64-64.03]) was a strong predictor. Among survivors, 20 patients (80%) had partial or complete renal recovery. Preexisting renal insufficiency (3.13 [0.34-29.13]) and high net ultrafiltration quantities (3.30 [0.40-26.90]) were the strongest predictors for failing renal recovery. As a consequence of the small samples size none of the associations was statistically significant.
Presence of ARDS and high net ultrafiltration rates seem to represent key factors affecting prognosis in patients with AKI undergoing IHD. Targeting these risk factors may improve the poor prognosis of these patients.
尽管在急性肾损伤（AKI）危重症患者的管理方面取得了进展，但其预后仍然很差。关于这些患者不良结局风险因素的证据基础很少。我们的目的是确定接受间歇性血液透析（IHD）的AKI患者的结局预测因素。
我们回顾性分析了2002年至2006年在一家教学二级护理医院接受IHD治疗的连续性AKI危重症患者的病历。我们使用多变量Cox比例风险回归分析来确定死亡率、血液透析期间血流动力学不稳定和肾脏恢复失败的预测因素。
我们共纳入39例患者，平均急性生理与慢性健康状况评分系统（APACHE II）评分为20.1（标准差7.5），平均进行了5.1±4.8次血液透析治疗。全因死亡率为35.9%（14/39例患者）。在多变量分析中，既往存在心脏合并症（风险比[HR]1.92[0.58 - 6.47]）、代谢性酸中毒（2.40[0.74 - 7.74]）和急性呼吸窘迫综合征（ARDS）的存在（1.83[0.52 - 6.46]）是最强的预测因素。7例患者（18%）在血液透析期间出现新的血流动力学不稳定，其中ARDS（6.42[0.64 - 64.03]）是一个强预测因素。在幸存者中，20例患者（80%）有部分或完全的肾脏恢复。既往存在肾功能不全（3.13[0.34 - 29.13]）和高净超滤量（3.30[0.40 - 26.90]）是肾脏恢复失败的最强预测因素。由于样本量小，这些关联均无统计学意义。
ARDS的存在和高净超滤率似乎是影响接受IHD的AKI患者预后的关键因素。针对这些风险因素可能改善这些患者的不良预后。
