An Na, Chen Ruman, Bai Yafei, Xu Mingzhi
Blood Purification Center, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University) Haikou, Hainan Province, China.
Am J Transl Res. 2021 Jun 15;13(6):7124-7131. eCollection 2021.
To investigate the efficacy and prognosis of CRRT at different times in the treatment of sepsis-induced acute kidney injury (SAKI).
A total of 156 patients with SAKI were grouped into two groups in accordance with a random number table, with 78 patients in each group. Patients in the observation group (OG) were treated with early CRRT, and in the control group (CG), patients were treated with delayed CRRT. According to whether the patients died, there were 51 cases in the death group and 105 in the survival group. Renal function and inflammatory factors were compared before and after treatment; univariate and multilateral comparison were conducted to analyze the survival status of the patients.
After treatment, the blood urea nitrogen (BUN) and serum creatinine (Scr) in both groups fell below those prior to treatment, while the estimated glomerular filtration rate (eGFR) was elevated (P<0.01); the decrease of BUN and Scr in the OG was greater than that of the other group, while increase eGFR was more than that the other group (P<0.01). After treatment, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in both groups decreased compared to that prior to treatment (P<0.001); the decrease of the three factors in the OG was greater than that in the CG (P<0.05). The 60-day survival rate of patients in the OG was 76.92%, which was higher that of 57.69% in the CG (P<0.05). The age, acute physiology and chronic health enquiry (APACHE-II) score and proportion of chronic obstructive pulmonary disease (COPD) in the death group was elevated compared to those in the survival group, while the number of patients with early CRRT and eGFR level before treatment were lower than those in the survival group (P<0.05). Age was an independent risk factor for the prognosis of SAKI, and early CRRT was a protective factor for the prognosis (P<0.05).
Early CRRT for SAKI can improve the renal function and inflammatory state effectively, and reduce the mortality of patients. Age is an independent risk factor affecting the prognosis of patients with SAKI, and early CRRT is a protective factor for the prognosis.
探讨不同时机连续性肾脏替代治疗（CRRT）对脓毒症诱导的急性肾损伤（SAKI）的疗效及预后。
将156例SAKI患者按照随机数字表法分为两组，每组78例。观察组（OG）患者接受早期CRRT治疗，对照组（CG）患者接受延迟CRRT治疗。根据患者是否死亡，分为死亡组51例和存活组105例。比较治疗前后的肾功能及炎症因子；进行单因素及多因素比较以分析患者的生存状况。
治疗后，两组患者的血尿素氮（BUN）和血清肌酐（Scr）均低于治疗前，而估算肾小球滤过率（eGFR）升高（P<0.01）；观察组BUN和Scr的下降幅度大于对照组，eGFR的升高幅度也大于对照组（P<0.01）。治疗后，两组患者的C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）均较治疗前下降（P<0.001）；观察组这三项因子的下降幅度大于对照组（P<0.05）。观察组患者的60天生存率为76.92%，高于对照组的57.69%（P<0.05）。死亡组患者的年龄、急性生理与慢性健康状况评分系统（APACHE-II）评分及慢性阻塞性肺疾病（COPD）比例均高于存活组，而接受早期CRRT的患者数量及治疗前eGFR水平低于存活组（P<0.05）。年龄是SAKI预后的独立危险因素，早期CRRT是预后的保护因素（P<0.05）。
SAKI患者早期行CRRT可有效改善肾功能及炎症状态，降低患者死亡率。年龄是影响SAKI患者预后的独立危险因素，早期CRRT是预后的保护因素。
