三级医院急诊科患者肾衰竭的临床特征及预测因素：一项横断面研究
Clinical profile and predictors of renal failure in emergency department patients at a tertiary level hospital, a cross sectional study.
作者信息
Kasongo Nancy, Siziya Seta, Banda Justor
机构信息
Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia.
Copperbelt University School of Medicine, Ndola, Zambia.
出版信息
Afr J Emerg Med. 2022 Dec;12(4):456-460. doi: 10.1016/j.afjem.2022.10.010. Epub 2022 Nov 10.
BACKGROUND
Since establishment of the emergency departments (ED) in the country, there is lack of information on clinical profile of patients admitted to the ED and predictors of renal failure in these patients. Renal failure is prevalent in critical patients and a cause of significant mortality and morbidity. The aim of this study was to assess the clinical profile and predictors of renal failure in admissions to the ED.
METHODS
This was a cross-sectional study that was conducted at a tertiary level hospital in Zambia from January to December, 2019 among admissions to the ED after ethical approval. The primary outcome of the study was to describe the clinical profile of admissions to the ED and proportion of renal failure defined as estimated glomerular filtration rate (eGFR) < 60 mls/1.72 m.
RESULTS
The final analysis includes 152 patients, 7 excluded for missing key data. The median age was 43.5 years (IQR 32.5-59.5) and 94.7% of patients were medical. Nearly 70.0% of the patients were triaged as emergency (red) or very urgent (orange). The reason for admission to the ED were sepsis and/or sepsis shock in 25.0%, diabetic hyperglycaemia emergencies in 20.0%, hypertensive crisis in 10.5%, respiratory failure (9.9%), severe malaria (7.9%) and poisoning (5.0%). The prevalence of renal failure was 36.1% and proteinuria was observed in 23.0%. Oliguria and hypertension were 5.9-fold and 1.7-fold independent predictors of renal failure in the ED. Patients with renal failure were likely older, hypertensive, oliguric and anaemic compared to those without. During admission to the ED, 19.1% died.
CONCLUSION
Sepsis and diabetic and hypertensive emergencies accounted for nearly half of ED admissions. Hypertension and oliguria were key predictors of renal failure. Early diagnosis, management and follow-up of hypertension including urine output monitoring for high-risk patients is key in surveillance and prevention of renal failure.
背景
自该国设立急诊科以来，缺乏关于急诊科收治患者的临床特征以及这些患者肾衰竭预测因素的信息。肾衰竭在危重症患者中很常见，是导致显著死亡率和发病率的原因。本研究的目的是评估急诊科收治患者的临床特征和肾衰竭的预测因素。
方法
这是一项横断面研究，于2019年1月至12月在赞比亚的一家三级医院对急诊科收治患者进行，研究经过伦理批准。该研究的主要结果是描述急诊科收治患者的临床特征以及定义为估计肾小球滤过率（eGFR）<60ml/1.72m²的肾衰竭比例。
结果
最终分析纳入152例患者，7例因关键数据缺失被排除。中位年龄为43.5岁（四分位间距32.5 - 59.5），94.7%的患者为内科患者。近70.0%的患者被分诊为紧急（红色）或非常紧急（橙色）。急诊科收治的原因分别为：脓毒症和/或脓毒症休克占25.0%，糖尿病高血糖急症占20.0%，高血压危象占10.5%，呼吸衰竭占9.9%，重症疟疾占7.9%，中毒占5.0%。肾衰竭的患病率为36.1%，蛋白尿的发生率为23.0%。少尿和高血压分别是急诊科肾衰竭的5.9倍和1.7倍独立预测因素。与无肾衰竭患者相比，肾衰竭患者年龄可能更大、患有高血压、少尿且贫血。在急诊科住院期间，19.1%的患者死亡。
结论
脓毒症以及糖尿病和高血压急症占急诊科收治患者的近一半。高血压和少尿是肾衰竭的关键预测因素。对高血压进行早期诊断、管理和随访，包括对高危患者进行尿量监测，是监测和预防肾衰竭的关键。
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