Zhu Ming-li, Ni Zhao-hui, Yan Yu-cheng, Gu Yong, Xue Jun, Chen Nan, Zhang Wen, Yuan Wei-jie, Wu Hao, Mei Chang-lin, Ye Zhao-yang, Qian Jia-qi
Shanghai Acute Renal Failure Work Group, Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200127, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2011 Jul;23(7):421-5.
To investigate the impact of therapeutic time on the prognosis in critically ill patients with acute renal failure (ARF) who needed renal replacement therapy (RRT), and to analyze the risk factors of death.
All data were retrieved from the Database of Early Diagnosis and Treatment in Acute Renal Failure in Shanghai. Eighty-eight patients were collected with 56 males and 32 females who accepted continuous veno-venous hemofiltration (CVVH). The mean age was (55.73 ± 16.33) years old. Patients were divided into two groups according to therapeutic time: short time group (6-12 hours, n=49) and long time group (>12 hours, n=39). The differences between two groups before and after treatment were compared. Kaplan-Meier survival analysis, the Log-rank test was performed to evaluate the prognosis of ARF patients on 15, 30 and 60 days. Cox regression analysis was performed to evaluate the risk factors affected the patient survival.
There were no significant difference of age, surgery, chronic kidney disease (CKD), diabetes, multiple organ failure (MOF) and severity of disease between two groups before treatment. Compared with that before treatment, blood pH, HCO(-)(3) were increased, and K(+), blood urea nitrogen (BUN), serum creatinine (SCr) were decreased after treatment (all P <0.05). There were no significant difference of Na(+) concentration and heart rate (HR), mean arterial pressure (MAP) after treatment. Kaplan-Meier survival analysis showed the survival rate of short time group and long time group were 64.4% vs. 51.4%, 52.8% vs. 46.2% and 50.4% vs.41.0% on 15, 30 and 60 days respectively. No significant difference in survival rate was noted (P=1.234). Cox regression analysis showed that the independent risk factors of short time mortality were diabetes [hazard ratio (HR)=2.134, 95% confidence interval (95%CI) 1.093-4.167,P<0.05] and MOF(HR 1.564, 95%CI 1.233-1.984,P<0.01).
The mortality of ARF in critical ill patients remains high, despite accepted renal replacement therapy. The therapeutic time of CVVH may not affect the patient survival not with standing the duration of renal replacement therapy. In our group, diabetes and MOF were the independent risk factors of patients death.
探讨治疗时机对需要肾脏替代治疗（RRT）的急性肾衰竭（ARF）危重症患者预后的影响，并分析死亡的危险因素。
所有数据均来自上海急性肾衰竭早期诊断与治疗数据库。收集88例接受持续静静脉血液滤过（CVVH）治疗的患者，其中男性56例，女性32例。平均年龄为（55.73±16.33）岁。根据治疗时间将患者分为两组：短时间组（6 - 12小时，n = 49）和长时间组（>12小时，n = 39）。比较两组治疗前后的差异。采用Kaplan - Meier生存分析和Log - rank检验评估ARF患者在15天、30天和60天时的预后。进行Cox回归分析以评估影响患者生存的危险因素。
两组治疗前在年龄、手术史、慢性肾脏病（CKD）、糖尿病、多器官功能衰竭（MOF）和疾病严重程度方面无显著差异。与治疗前相比，治疗后血pH值、HCO₃⁻升高，K⁺、血尿素氮（BUN）、血清肌酐（SCr）降低（均P < 0.05）。治疗后Na⁺浓度、心率（HR）、平均动脉压（MAP）无显著差异。Kaplan - Meier生存分析显示，短时间组和长时间组在15天、30天和60天的生存率分别为64.4%对51.4%、52.8%对46.2%和50.4%对41.0%。生存率无显著差异（P = 1.234）。Cox回归分析显示，短时间死亡的独立危险因素为糖尿病[风险比（HR）= 2.134，95%置信区间（95%CI）1.093 - 4.167，P < 0.05]和MOF（HR 1.564，95%CI 1.233 - 1.984，P < 0.01）。
尽管接受了肾脏替代治疗，但ARF危重症患者的死亡率仍然很高。CVVH的治疗时间可能不影响患者生存，无论肾脏替代治疗的持续时间如何。在我们的研究组中，糖尿病和MOF是患者死亡的独立危险因素。
