Xue Xiang, Zhu Shuhua, Xu Shutian, Zhou Yuchao, Wang Yang, Lou Lixuan, Li Shijun
National Clinical Research Center of Kidney Disease, Nanjing Medical University, Jingling Hospital, Nanjing, China.
Immun Inflamm Dis. 2025 Feb;13(2):e70152. doi: 10.1002/iid3.70152.
Multiple organ dysfunction syndrome (MODS), defined as two or more organ dysfunction during infection or following shock or trauma, correlates with poor outcomes. Clinical data, including MODS in the renal intensive care unit (ICU), are scarce. Therefore, we investigate the clinical characteristics and prognosis of patients with MODS in the renal ICU.
A single-center, retrospective cohort study of 99 adult patients with MODS admitted to the renal ICU of the National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing, China, from October 1, 2011 to October 1, 2021.
99 patients had a mean age of 49.7 ± 16.5 years old, and 51 (51.5%) patients died within 28 days after being admitted to the renal ICU. Infection (80 patients, 80.8%) was the most common reason for admission, with 47 cases being pulmonary infections. Of all of the 99 patients, 73 (73.7%) presented with persistent lymphocytopenia (lymphocyte count < 1.1 × 10/L from the day of ICU admission through to day 7), with 33 and 40 presenting moderate (lymphocyte count 0.6-1.1 × 10/L) and severe persistent lymphopenia (lymphocyte count ≤ 0.6 × 10/L), respectively. These patients had higher illness severity and chronic kidney disease (CKD) prevalence. Patients with severe persistent lymphopenia were associated with higher 28-day ICU mortality (87.5% vs. 42.4% vs. 7.7%, p < 0.001) versus those with moderate and without persistent lymphopenia. Multivariable logistic regression analysis revealed that the number of organs involved, APACHE-II score, and persistent lymphopenia were independent risk factors for 28-day mortality in patients with MODS. The value of lymphocyte count on day 7 of admission in predicting poor prognosis of patients was higher than on other days (Area Under Curve, AUC = 0.831).
Patients with MODS are critically ill with high mortality. Persistent lymphopenia is frequent in patients with MODS and is independently associated with 28-day mortality. Lymphocyte counts on day 7 of admission were shown to be highly predictive of prognosis.
多器官功能障碍综合征（MODS）被定义为在感染期间或休克或创伤后出现两个或更多器官功能障碍，与不良预后相关。包括肾脏重症监护病房（ICU）中MODS的临床数据较为匮乏。因此，我们研究了肾脏ICU中MODS患者的临床特征和预后。
一项单中心回顾性队列研究，研究对象为2011年10月1日至2021年10月1日期间入住中国南京金陵医院国家肾脏疾病临床研究中心肾脏ICU的99例成年MODS患者。
99例患者的平均年龄为49.7±16.5岁，51例（51.5%）患者在入住肾脏ICU后28天内死亡。感染（80例，80.8%）是最常见的入院原因，其中47例为肺部感染。在所有99例患者中，73例（73.7%）出现持续性淋巴细胞减少（从入住ICU当天至第7天淋巴细胞计数<1.1×10⁹/L），其中33例和40例分别出现中度（淋巴细胞计数0.6 - 1.1×10⁹/L）和重度持续性淋巴细胞减少（淋巴细胞计数≤0.6×10⁹/L）。这些患者的疾病严重程度和慢性肾脏病（CKD）患病率更高。与中度和无持续性淋巴细胞减少的患者相比，重度持续性淋巴细胞减少的患者28天ICU死亡率更高（87.5%对42.4%对7.7%，p<0.001）。多变量逻辑回归分析显示，受累器官数量、急性生理与慢性健康状况评分系统II（APACHE-II）评分和持续性淋巴细胞减少是MODS患者28天死亡率的独立危险因素。入院第7天的淋巴细胞计数预测患者预后不良的价值高于其他天数（曲线下面积，AUC = 0.831）。
MODS患者病情危重，死亡率高。持续性淋巴细胞减少在MODS患者中很常见，且与28天死亡率独立相关。入院第7天的淋巴细胞计数对预后具有高度预测性。
