免疫检查点抑制剂治疗患者急性肾损伤的发生率、风险因素和预后:一项回顾性研究。
Incidence, risk factors and prognosis of acute kidney injury in patients treated with immune checkpoint inhibitors: a retrospective study.
机构信息
Department of Nephropathy, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, 100853, China.
出版信息
Sci Rep. 2022 Nov 5;12(1):18752. doi: 10.1038/s41598-022-21912-y.
Immune checkpoint inhibitors (ICIs) change the prognosis of many cancer patients. With the increasing use of ICIs, immune-related adverse events are occurring, including acute kidney injury (AKI). This study aimed to assess the incidence of AKI during ICI treatment and its risk factors and impact on mortality. Patients treated with ICIs at the First Medical Center of the Chinese PLA General Hospital from January 1, 2014, to December 30, 2019, were consecutively enrolled, and risk factors affecting AKI development in patients treated with ICIs were analyzed using univariate and multivariate logistic regression. Medical record surveys and telephone inquiry were used for follow-up, and Kaplan-Meier survival analysis and Cox regression were used to analyze independent risk factors for death. Among 1615 patients, 114 (7.1%) had AKI. Multivariate logistic regression analysis showed that anemia, Alb < 30 g/L, antibiotic use, diuretic use, NSAID use and proton pump inhibitor use were independent risk factors for AKI development in patients treated with ICIs. Stage 2 or 3 AKI was an independent risk factor for nonrecovery of renal function after AKI onset. Multivariate Cox regression analysis showed that anemia, Alb < 30 g/L, AKI occurrence, and diuretic use were independent risk factors for death in patients treated with ICIs, while high baseline BMI, other tumor types, ACEI/ARB use, and chemotherapy use were protective factors for patient death. AKI occurs in 7.1% of patients treated with ICIs. Anemia, Alb < 30 g/L, and combined medication use are independent risk factors for AKI in patients treated with ICIs. Anemia, Alb < 30 g/L, AKI occurrence, and diuretic use were independent risk factors for death in patients treated with ICIs.
免疫检查点抑制剂 (ICI) 改变了许多癌症患者的预后。随着 ICI 的应用越来越广泛,免疫相关不良反应也在发生,包括急性肾损伤 (AKI)。本研究旨在评估 ICI 治疗期间 AKI 的发生率及其危险因素和对死亡率的影响。
连续纳入 2014 年 1 月 1 日至 2019 年 12 月 30 日在解放军总医院第一医学中心接受 ICI 治疗的患者,采用单因素和多因素 logistic 回归分析影响 ICI 治疗患者 AKI 发生的危险因素。采用病历调查和电话询问进行随访,采用 Kaplan-Meier 生存分析和 Cox 回归分析死亡的独立危险因素。
在 1615 例患者中,114 例(7.1%)发生 AKI。多因素 logistic 回归分析显示,贫血、Alb<30 g/L、抗生素使用、利尿剂使用、非甾体抗炎药使用和质子泵抑制剂使用是 ICI 治疗患者 AKI 发生的独立危险因素。AKI 分期 2 或 3 期是 AKI 后肾功能未恢复的独立危险因素。多因素 Cox 回归分析显示,贫血、Alb<30 g/L、AKI 发生和利尿剂使用是 ICI 治疗患者死亡的独立危险因素,而基线 BMI 较高、其他肿瘤类型、ACEI/ARB 使用和化疗使用是患者死亡的保护因素。
ICI 治疗患者 AKI 发生率为 7.1%。贫血、Alb<30 g/L 和联合用药是 ICI 治疗患者 AKI 的独立危险因素。贫血、Alb<30 g/L、AKI 发生和利尿剂使用是 ICI 治疗患者死亡的独立危险因素。