Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania.
Hospital of Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania.
Medicina (Kaunas). 2021 Oct 9;57(10):1076. doi: 10.3390/medicina57101076.
: Acute kidney injury (AKI) remains a serious health condition around the world, and is related to high morbidity, mortality, longer hospitalization duration and worse long-term outcomes. The aim of our study was to estimate the significant related factors for poor outcomes of patients with severe AKI requiring renal replacement therapy (RRT). : We retrospectively analyzed data from patients ( = 573) with severe AKI requiring RRT within a 5-year period and analyzed the outcomes on discharge from the hospital. We also compared the clinical data of the surviving and non-surviving patients and examined possible related factors for poor patient outcomes. Logistic regression was used to analyze the odds ratio for patient mortality and its related factors. In 32.5% ( = 186) of the patients, the renal function improved and RRT was stopped, 51.7% ( = 296) of the patients died, and 15.9% ( = 91) of the patients remained dialysis-dependent on the day of discharge from the hospital. During the period of 5 years, the outcomes of the investigated patients did not change statistically significantly. Administration of vasopressors, aminoglycosides, sepsis, pulmonary edema, oliguria, artificial pulmonary ventilation (APV), patient age ≥ 65 y, renal cause of AKI, AKI after cardiac surgery, a combination of two or more RRT methods, dysfunction of three or more organs, systolic blood pressure (BP) ≤ 120 mmHg, diastolic BP ≤ 65 mmHg, and Sequential Organ Failure Assessment (SOFA) score on the day of the first RRT procedure ≥ 7.5 were related factors for lethal patient outcome. The mortality rate among patients with severe AKI requiring RRT is very high-52%. Patient death was significantly predicted by the causes of AKI (sepsis, cardiac surgery), clinical course (oliguria, pulmonary edema, hypotension, acidosis, lesion of other organs) and the need for a continuous renal replacement therapy.
急性肾损伤(AKI)仍然是全世界严重的健康问题,与高发病率、死亡率、住院时间延长和更差的长期预后有关。我们的研究目的是评估需要肾脏替代治疗(RRT)的严重 AKI 患者不良预后的相关因素。
我们回顾性分析了 5 年内需要 RRT 的严重 AKI 患者(n=573)的数据,并分析了出院时的结局。我们还比较了存活和非存活患者的临床数据,并检查了患者不良预后的可能相关因素。使用逻辑回归分析患者死亡率及其相关因素的比值比。在 32.5%(n=186)的患者中,肾功能改善,RRT 停止,51.7%(n=296)的患者死亡,15.9%(n=91)的患者在出院当天仍依赖透析。在 5 年期间,研究患者的结局没有统计学显著变化。血管加压素、氨基糖苷类药物、脓毒症、肺水肿、少尿、人工通气(APV)、患者年龄≥65 岁、AKI 的肾脏原因、心脏手术后 AKI、两种或更多 RRT 方法的联合使用、三个或更多器官功能障碍、收缩压(BP)≤120mmHg、舒张压≤65mmHg,以及首次 RRT 时的序贯器官衰竭评估(SOFA)评分≥7.5,是患者致命结局的相关因素。需要 RRT 的严重 AKI 患者的死亡率非常高-52%。AKI 的病因(脓毒症、心脏手术)、临床病程(少尿、肺水肿、低血压、酸中毒、其他器官损伤)和对持续肾脏替代治疗的需求,显著预测了患者的死亡。