Yang Yong, Dong Jun, Chen Xiaojie, Chen Renxiong, Wang Hongzhi
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Critical Care Medicine, Peking University Cancer Hospital and Institute, Beijing, China.
Front Med (Lausanne). 2022 Dec 14;9:1015735. doi: 10.3389/fmed.2022.1015735. eCollection 2022.
The purpose of this study was to clarify the incidence, risk factors, and clinical outcomes of septic acute kidney injury (AKI) in cancer patients with sepsis admitted to the intensive care unit (ICU).
A total of 356 cancer patients admitted to the ICU due to sepsis from January 2016 to October 2021 were analyzed retrospectively. According to the incidence of septic AKI, all patients were divided into the non-AKI group ( = 279) and the AKI group ( = 77). The clinical data after ICU admission were compared between the above two groups, and the risk factors and the clinical outcomes of septic AKI in the ICU were identified.
The incidence of septic AKI in all patients was 21.6% (77/356). LASSO regression and logistic regression all showed that lactate, sequential organ failure assessment (SOFA) score and septic shock were closely related to the occurrence of septic AKI. In terms of clinical outcomes after ICU admission, the rate of mechanical ventilation (MV) and continuous renal replacement therapy (CRRT), MV time, hospitalization time and 28-day mortality in the ICU were significantly higher in the septic AKI group than in the non-septic AKI group. Among the three subgroups of septic AKI (AKI combined with septic shock, septic cardiac dysfunction or acute respiratory failure), the mortality of patients in the subgroup of AKI combined with septic shock was significantly higher than others. CRRT has no significant effect on the short-term outcome of these patients.
Lactate level, SOFA score and septic shock were closely related to the occurrence of septic AKI in the ICU. The clinical outcomes within 28 days after ICU admission of cancer patients with septic AKI were worse than those without septic AKI. The short-term outcome was worse in patients with septic AKI complicated with septic shock. CRRT does not have any significant effect on the short-term prognosis of cancer patients with septic AKI in the ICU.
本研究旨在阐明入住重症监护病房（ICU）的癌症合并脓毒症患者中，脓毒症相关性急性肾损伤（AKI）的发病率、危险因素及临床结局。
回顾性分析2016年1月至2021年10月因脓毒症入住ICU的356例癌症患者。根据脓毒症相关性AKI的发病率，将所有患者分为非AKI组（n = 279）和AKI组（n = 77）。比较上述两组患者入住ICU后的临床资料，确定ICU中脓毒症相关性AKI的危险因素及临床结局。
所有患者中脓毒症相关性AKI的发病率为21.6%（77/356）。LASSO回归和逻辑回归均显示，乳酸水平、序贯器官衰竭评估（SOFA）评分及脓毒性休克与脓毒症相关性AKI的发生密切相关。在入住ICU后的临床结局方面，脓毒症相关性AKI组的机械通气（MV）率、持续肾脏替代治疗（CRRT）率、MV时间、住院时间及ICU内28天死亡率均显著高于非脓毒症相关性AKI组。在脓毒症相关性AKI的三个亚组（AKI合并脓毒性休克、脓毒症性心功能不全或急性呼吸衰竭）中，AKI合并脓毒性休克亚组患者的死亡率显著高于其他亚组。CRRT对这些患者的短期结局无显著影响。
乳酸水平、SOFA评分及脓毒性休克与ICU中脓毒症相关性AKI的发生密切相关。癌症合并脓毒症相关性AKI患者入住ICU后28天内的临床结局比未发生脓毒症相关性AKI的患者更差。脓毒症相关性AKI合并脓毒性休克的患者短期结局更差。CRRT对ICU中癌症合并脓毒症相关性AKI患者的短期预后无显著影响。
