Chang Ko-Wei, Leu Shaw-Woei, Lin Shih-Wei, Liang Shinn-Jye, Yang Kuang-Yao, Chan Ming-Cheng, Chen Wei-Chih, Hu Han-Chung, Fang Wen-Feng, Chen Yu-Mu, Sheu Chau-Chyun, Tsai Ming-Ju, Wang Hao-Chien, Chien Ying-Chun, Peng Chung-Kan, Wu Chieh-Liang, Kao Kuo-Chin
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan.
J Clin Med. 2021 Apr 23;10(9):1837. doi: 10.3390/jcm10091837.
Acute kidney injury (AKI) requiring renal replacement therapy (RRT) increases the mortality of acute respiratory distress syndrome (ARDS) patients. The aim of this study was to investigate the outcomes and predictors of RRT in patients with influenza pneumonia-related ARDS. This retrospective cohort study includes patients from eight tertiary referral centers in Taiwan between January and March 2016, and all 282 patients with influenza pneumonia-related ARDS were enrolled. Thirty-four patients suffered from AKI requiring RRT, while 16 patients had underlying end stage renal disease (ESRD). The 30- and 60-day mortality rates were significantly higher in patients with AKI requiring RRT compared with those not requiring RRT (50.0% vs. 19.8%, value < 0.001; 58.8% vs. 27.2%, value = 0.001, respectively), but the patients with ESRD had no significant difference in mortality (12.5% vs. 19.8%, value = 0.744; 31.3% vs. 27.2%, value = 0.773, respectively). The predictors for AKI requiring RRT included underlying chronic liver disease and C-reactive protein. The mortality predictors for patients with AKI requiring RRT included the pneumonia severity index, tidal volume, and continuous renal replacement therapy. In this study, patients with influenza pneumonia-related ARDS with AKI requiring RRT had significantly higher mortality compared with other patients.
需要肾脏替代治疗（RRT）的急性肾损伤（AKI）会增加急性呼吸窘迫综合征（ARDS）患者的死亡率。本研究旨在调查流感肺炎相关ARDS患者接受RRT的结局及预测因素。这项回顾性队列研究纳入了2016年1月至3月台湾8家三级转诊中心的患者，共纳入282例流感肺炎相关ARDS患者。34例患者发生AKI需要RRT，16例患者患有基础终末期肾病（ESRD）。需要RRT的AKI患者的30天和60天死亡率显著高于不需要RRT的患者（分别为50.0%对19.8%，P值<0.001；58.8%对27.2%，P值=0.001），但ESRD患者的死亡率无显著差异（分别为12.5%对19.8%，P值=0.7,44；31.3%对27.2%，P值=0.773）。需要RRT的AKI的预测因素包括基础慢性肝病和C反应蛋白。需要RRT的AKI患者的死亡预测因素包括肺炎严重程度指数、潮气量和连续性肾脏替代治疗。在本研究中，流感肺炎相关ARDS且发生AKI需要RRT的患者的死亡率显著高于其他患者。
