HIV/AIDS患者的连续性肾脏替代治疗

Continuous renal replacement therapy in patients with HIV/AIDS.

作者信息

Guo Hebing, Liu Jingyuan, Pu Lin, Hao Jingjing, Yin Ningning, Liu Yufeng, Xiong Haofeng, Li Ang

机构信息

Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China.

出版信息

BMC Nephrol. 2020 Mar 11;21(1):95. doi: 10.1186/s12882-020-01754-4.

DOI:10.1186/s12882-020-01754-4

PMID:32160882

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7066780/

Abstract

BACKGROUND

Acute kidney injury (AKI) is a common complication among human immunodeficiency virus (HIV)-infected patients resulting in increased morbidity and mortality. Continuous renal replacement therapy (CRRT) is a useful method and instrument in critically ill patients with fluid overload and metabolic disarray, especially in those who are unable to tolerate the intermittent hemodialysis. However, the epidemiology, influence factors of CRRT and mortality in patients with HIV/AIDS are still unclear in China. This study aims to study the HIV-infected patients admitted in Intensive Care Unit (ICU) and explore the influence factors correlated with CRRT and their prognosis.

METHODS

We performed a retrospective case-control study in the ICU of the Beijing Ditan Hospital Capital Medical University. From June 1, 2005 to May 31, 2017, 225 cases were enrolled in this clinical study.

RESULTS

122 (54.2%) patients were diagnosed with AKI during their stay in ICU, the number and percentage of AKI stage 1, 2 and 3 were 38 (31.1%), 21(17.2%) and 63(51.7%), respectively. 26.2% of AKI patients received CRRT during the stay of ICU. 56.25% CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. By univariate logistics analysis, it showed that higher likelihood of diagnosis for respiratory failure (OR = 7.333,95% CI 1.467-36.664, p = 0.015), higher likelihood of diagnosis for septic shock (OR = 1.005,95% CI 1.001-1.01, p = 0.018), and higher likelihood to use vasoactive agents (OR = 10.667,95% CI 1.743-65.271, p = 0.001), longer mechanical ventilation duration (OR = 1.011,95% CI 1.002-1.019, p = 0.011), higher likelihood for diagnosis for PCP (OR = 7.50,95% CI 1.288-43.687, p = 0.025), higher SOFA score at ICU admission (OR = 1.183,95% CI 1.012-1.383, p = 0.035), longer duration of CRRT (OR = 1.014,95% CI 1.001-1.028, p = 0.034) contributed to a higher mortality at ICU. The Cox Analysis for the cumulative survival of AKI 3 patients between the CRRT and non-CRRT groups shows no significant differences (p = 0.595).

CONCLUSIONS

There is a high incidence of AKI in HIV-infected patients admitted in our ICU. Patients with severe AKI were more prone to be admitted for CRRT and have a consequent poor prognosis.

摘要

背景

急性肾损伤（AKI）是人类免疫缺陷病毒（HIV）感染患者常见的并发症，会导致发病率和死亡率升高。连续性肾脏替代治疗（CRRT）是治疗伴有液体超负荷和代谢紊乱的危重症患者，尤其是无法耐受间歇性血液透析患者的有效方法和手段。然而，中国HIV/AIDS患者接受CRRT治疗的流行病学、影响因素及死亡率仍不明确。本研究旨在研究入住重症监护病房（ICU）的HIV感染患者，探讨与CRRT相关的影响因素及其预后情况。

方法

我们在北京地坛医院首都医科大学ICU进行了一项回顾性病例对照研究。2005年6月1日至2017年5月31日期间，共有225例患者纳入本临床研究。

结果

122例（54.2%）患者在ICU住院期间被诊断为AKI，AKI 1期、2期和3期的例数及百分比分别为38例（31.1%）、21例（17.2%）和63例（51.7%）。26.2%的AKI患者在ICU住院期间接受了CRRT治疗。56.25%接受CRRT治疗的患者在ICU死亡。28天死亡率为62.5%，90天死亡率为75%。单因素逻辑回归分析显示，呼吸衰竭诊断可能性更高（OR = 7.333，95% CI 1.467 - 36.664，p = 0.015）、脓毒性休克诊断可能性更高（OR = 1.005，95% CI 1.001 - 1.01，p = 0.018）、使用血管活性药物可能性更高（OR = 10.667，95% CI 1.743 - 65.271，p = 0.001）、机械通气时间更长（OR = 1.011，95% CI 1.002 - 1.019，p = 0.011）、肺孢子菌肺炎（PCP）诊断可能性更高（OR = 7.50，95% CI 1.288 - 43.687，p = 0.025）、入住ICU时序贯器官衰竭评估（SOFA）评分更高（OR = 1.183，95% CI 1.012 - 1.383，p = 0.035）、CRRT持续时间更长（OR = 1.014，95% CI 1.001 - 1.028，p = 0.034）均导致ICU死亡率更高。对CRRT组和非CRRT组AKI 3期患者的累积生存率进行Cox分析，结果显示无显著差异（p = 0.595）。