Shah Pankaj R, Gireesh M S, Kute Vivek B, Vanikar Aruna V, Gumber Manoj R, Patel Himanshu V, Goplani K R, Trivedi Hargovind L
Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Asarwa, Ahmedabad, India.
Saudi J Kidney Dis Transpl. 2013 May;24(3):620-9. doi: 10.4103/1319-2442.111089.
Acute kidney injury (AKI) is an independent risk factor for mortality in sepsis syndrome. Few Indian studies have focused on describing the epidemiology of sepsis with AKI. Adult patients with sepsis-induced AKI were evaluated for the clinical characteristics and outcome and to correlate various parameters associated with sepsis to the outcome of patients. This prospective study included 136 patients with sepsis-induced AKI between 2007 and 2009. All patients required renal replacement therapy. Males comprised 44% of the patients while 56% were females; their mean age was 38.6 years. When we compared the survivor and non-survivor groups, it was found that mortality was associated with delayed presentation (6.8 vs 9.4 days), presence of hypotension (132/80 vs 112/70 mmHg), oliguria (300 vs 130 mL), anemia (8 vs 9.3 gm/dL), prolonged prothrombin time (15 vs 29 s) and activated partial thrombin time (38 vs 46 s), creatinine (7.8 vs 6.4 mg/dL), blood urea (161 vs 135 mg/dL), higher D-dimer (1603 vs 2185), short hospital stay (27.9 vs 8.3 days), number of hemodialysis sessions (11.9 vs 6 times), need for vasopressors (14% vs 52%) and ventilator (7.2% vs 75%) and higher Sequential Organ Failure Assessment (SOFA) score (6.7 vs 11.4) (P <0.05). The most com-mon source of infection in this study was urogenital tract (34%). About 51.4% showed complete recovery of renal function. The overall hospital mortality rate was 38.9%. Less than 10% of the patients developed impaired renal function following septic AKI. In conclusion, the most common renal manifestation of sepsis was AKI, which is a risk factor for mortality in sepsis syndrome. SOFA score >11 and multi-organ dysfunction are the risk factors for mortality.
急性肾损伤（AKI）是脓毒症综合征患者死亡的独立危险因素。印度很少有研究关注脓毒症合并AKI的流行病学情况。对成年脓毒症诱导的AKI患者的临床特征及预后进行评估，并将与脓毒症相关的各项参数与患者的预后进行关联分析。这项前瞻性研究纳入了2007年至2009年间136例脓毒症诱导的AKI患者。所有患者均需接受肾脏替代治疗。男性患者占44%，女性患者占56%；平均年龄为38.6岁。比较存活组和非存活组时发现，死亡与就诊延迟（6.8天对9.4天）、低血压（132/80 mmHg对112/70 mmHg）、少尿（300 mL对130 mL）、贫血（8 g/dL对9.3 g/dL）、凝血酶原时间延长（15秒对29秒）、活化部分凝血活酶时间（38秒对46秒）、肌酐（7.8 mg/dL对6.4 mg/dL）、血尿素（161 mg/dL对135 mg/dL）、D-二聚体升高（1603对2185）、住院时间短（27.9天对8.3天）、血液透析次数（11.9次对6次）、需要血管升压药（14%对52%）和呼吸机（7.2%对75%）以及序贯器官衰竭评估（SOFA）评分较高（6.7对11.4）相关（P<0.05）。本研究中最常见的感染源是泌尿生殖道（34%）。约51.4%的患者肾功能完全恢复。总体医院死亡率为38.9%。脓毒症性AKI后不到10%的患者出现肾功能损害。总之，脓毒症最常见的肾脏表现是AKI，这是脓毒症综合征患者死亡的危险因素。SOFA评分>11和多器官功能障碍是死亡的危险因素。
