重症监护病房急性肾损伤患者的预后指标。
Prognostic indicators of patients with acute kidney injury in intensive care unit.
机构信息
ICU, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China.
出版信息
World J Emerg Med. 2010;1(3):209-11.
BACKGROUND
Acute kidney injury (AKI) is associated with a high mortality. This study was undertaken to detect the factors associated with the prognosis of AKI.
METHODS
We retrospectively reviewed 98 patients with AKI treated from March 2008 to August 2009 at this hospital. In these patients, 60 were male and 38 female. Their age ranged from 19 to 89 years (mean 52.4±16.1 years). The excluded patients were those who died within 24 hours after admission to ICU or those who had a history of chronic kidney disease or incomplete data. After 60 days of treatment, the patients were divided into a survival group and a death group. Clinical data including gender, age, history of chronic diseases, the worst laboratory values within 24 hours after diagnosis (values of routine blood tests, blood gas analysis, liver and renal function, levels of serum cystatin C, and blood electrolytes) were analyzed. Acute physiology, chronic health evaluation (APACHE) II scores and 60-day mortality were calculated. Univariate analysis was performed to find variables relevant to prognosis, odds ratio (OR) and 95% confidence interval (CI). Multiple-factor analysis with logistic regression analysis was made to analyze the correlation between risk factors and mortality.
RESULTS
The 60-day mortality was 34.7% (34/98). The APACHE II score of the death group was higher than that of the survival group (17.4±4.3 vs. 14.2±4.8, P<0.05). The mortality of the patients with a high level of cystatin C>1.3 mg/L was higher than that of the patients with a low level of cystatin C (<1.3 mg/L) (50% vs. 20%, P<0.05). The univariate analysis indicated that organ failures≥2, oliguria, APACHE II>15 scores, cystatin C>1.3 mg/L, cystatin C>1.3 mg/L+APACHE II>15 scores were the risk factors of AKI. Logistic regression analysis, however, showed that organ failures≥2, oliguria, cystatin C>1.3 mg/L +APACHE II>15 scores were the independent risk factors of AKI.
CONCLUSION
Cystatin C>1.3 mg/L+APACHE II>15 scores is useful in predicting adverse clinical outcomes in patients with AKI.
背景
急性肾损伤（AKI）与高死亡率相关。本研究旨在检测与 AKI 预后相关的因素。
方法
我们回顾性分析了 2008 年 3 月至 2009 年 8 月在我院治疗的 98 例 AKI 患者。其中男 60 例，女 38 例。年龄 19~89 岁，平均（52.4±16.1）岁。排除入院 24 小时内死亡或有慢性肾脏病病史或资料不全的患者。治疗 60 天后，将患者分为存活组和死亡组。分析临床资料，包括性别、年龄、慢性疾病史、诊断后 24 小时内最差的实验室值（常规血液检查、血气分析、肝肾功能、血清胱抑素 C 水平和血电解质）。计算急性生理与慢性健康评估（APACHE）Ⅱ评分和 60 天死亡率。单因素分析找出与预后相关的变量，计算比值比（OR）及其 95%置信区间（CI）。采用多因素 logistic 回归分析对危险因素与死亡率的相关性进行分析。
结果
60 天死亡率为 34.7%（34/98）。死亡组的 APACHEⅡ评分高于存活组（17.4±4.3 比 14.2±4.8，P<0.05）。胱抑素 C>1.3mg/L 水平较高的患者死亡率高于胱抑素 C<1.3mg/L 水平的患者（50%比 20%，P<0.05）。单因素分析表明，器官衰竭≥2 个、少尿、APACHEⅡ评分>15 分、胱抑素 C>1.3mg/L、胱抑素 C>1.3mg/L+APACHEⅡ评分>15 分是 AKI 的危险因素。然而，logistic 回归分析显示，器官衰竭≥2 个、少尿、胱抑素 C>1.3mg/L+APACHEⅡ评分>15 分是 AKI 的独立危险因素。
结论
胱抑素 C>1.3mg/L+APACHEⅡ评分有助于预测 AKI 患者的不良临床结局。
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