Silva Rafael Mendes da, Freitas Flavio Geraldo Rezende de, Bafi Antonio Tonete, Silva Junior Hélio Tedesco, Roza Bartira de Aguiar
Universidade Federal de São Paulo, Departamento de Enfermagem, São Paulo - SP, Brazil.
Universidade Federal de São Paulo, Hospital do Rim, Escola Paulista de Medicina, São Paulo - SP, Brazil.
J Bras Nefrol. 2017 Oct-Dec;39(4):433-440. doi: 10.5935/0101-2800.20170076.
The lungs are often involved in a variety of complications after kidney transplantation. Acute respiratory failure (ARF) is one of the most serious manifestations of pulmonary involvement.
To describe the main causes of ARF in kidney transplant patients who require intensive care and identify the factors associated with mortality.
This retrospective study evaluated adult patients with ARF admitted to the intensive care unit of a center with high volume of transplants from August 2013 to August 2015. Demographic, clinical, and transplant characteristics were analyzed. Multivariate logistic regression analysis was performed to identify factors associated with hospital mortality.
183 patients were included with age of 55.32 ± 13.56 years. 126 (68.8%) were deceased-donor transplant, and 37 (20.2%) patients had previous history of rejection. The ICU admission SAPS3 and SOFA score were 54.39 ± 10.32 and 4.81 ± 2.32, respectively. The main cause of hospitalization was community-acquired pneumonia (18.6%), followed by acute pulmonary edema (15.3%). Opportunistic infections were common: PCP (9.3%), tuberculosis (2.7%), and cytomegalovirus (2.2%). Factors associated with mortality were requirement for vasopressor (OD 8.13, CI 2.83 to 23.35, p < 0.001), invasive mechanical ventilation (OD 3.87, CI: 1.29 to 11.66, p = 0.016), and SAPS3 (OD 1.04, CI 1.0 to 1.08, p = 0.045).
Bacterial pneumonia is the leading cause of ARF requiring intensive care, followed by acute pulmonary edema. Requirement for vasopressor, invasive mechanical ventilation and SAP3 were associated with hospital mortality.
肾移植后肺部常出现各种并发症。急性呼吸衰竭（ARF）是肺部受累最严重的表现之一。
描述需要重症监护的肾移植患者发生ARF的主要原因，并确定与死亡率相关的因素。
这项回顾性研究评估了2013年8月至2015年8月期间在一个高移植量中心的重症监护病房收治的成年ARF患者。分析了人口统计学、临床和移植特征。进行多因素逻辑回归分析以确定与医院死亡率相关的因素。
纳入183例患者，年龄为55.32±13.56岁。126例（68.8%）为尸体供者移植，37例（20.2%）患者有既往排斥史。入住重症监护病房时的SAPS3和SOFA评分分别为54.39±10.32和4.81±2.32。住院的主要原因是社区获得性肺炎（18.6%），其次是急性肺水肿（15.3%）。机会性感染很常见：肺孢子菌肺炎（9.3%）、结核病（2.7%）和巨细胞病毒（2.2%）。与死亡率相关的因素是需要血管活性药物（比值比8.13，可信区间2.83至23.35，p<0.001）、有创机械通气（比值比3.87，可信区间：1.29至11.66，p = 0.016）和SAPS3（比值比1.04，可信区间1.0至1.08，p = 0.045）。
细菌性肺炎是需要重症监护的ARF的主要原因，其次是急性肺水肿。需要血管活性药物、有创机械通气和SAPS3与医院死亡率相关。
