脓毒症并发急性肾损伤患者临床特点及预后影响因素分析
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摘要
目的探讨脓毒症并发急性肾损伤患者临床特点,分析预后影响因素,提出相关干预措施以改善其预后。方法回顾性分析医院2014年11月~2017年6月80例脓毒症患者临床资料,查阅患者诊治病历,并对临床资料进行统计分析,根据患者是否并发急性肾损伤分为脓毒症并发急性肾损伤组与脓毒症非急性肾损伤组,比较两组患者间各项临床指标;并行Logistic多因素回归分析。采用受试者工作特征曲线(ROC曲线)比较SOFA与APACHEII评分对患者预后的评价作用。结果 80例脓毒症患者中,并发急性肾损伤者为39例(48.75%),死亡27例33.75%(27/80),其中脓毒症并发急性肾损伤组中,死亡者18例46.15%(18/39),高于脓毒症非急性肾损伤组21.95%(9/41)(χ2=5.231,P=0.024)。年龄、SOFA评分及动脉血PH值为脓毒症并发急性肾损伤的主要影响因素;而年龄、高SOFA评分及低动脉血PH值为脓毒症并发急性肾损伤的独立影响因素。APACHEII评分系统的AUC高于SOFA。结论脓毒症患者易发生急性肾损伤,且预后较差,脓毒症并发急性肾损伤的影响因素较多,因此临床需加强干预。
OBJECTIVE To explore the clinical characteristics of sepsis complicated with acute kidney injury,analyze prognostic factors,and put forward the relevant intervention measures to improve its prognosis.METHODS The clinical data of 80 patients with sepsis from Nov.2014 to Jun.2017 were retrospectively analyzed.The medical records of patients were consulted,and clinical data were statistically analyzed.According to whether patients with acute kidney injury,patients were divided into sepsis with acute kidney injury group and sepsis without acute kidney injury group,the clinical indexes of the two groups were compared,and logistic multivariate regression analysis were carried out.The effects of SOFA and APACHEII scores on the prognosis of patients were compared by using the receiver operating curve(ROC curve).RESULTS Among 80 patients with sepsis,39(48.75%)were with acute kidney injury.Among the 80 patients,27 cases died accounting for 33.75%(27/80).There were 18 cases(46.15%)of death in sepsis with acute kidney injury group,which was significantly higher than 9 cases(21.95%)in sepsis without acute kidney injury group(χ2=5.231,P=0.024).Age,SOFA score and arterial blood pH were the main influencing factors of acute kidney injury in sepsis,and age,high SOFA score and low arterial blood pH were the independent risk factors of sepsis complicated with acute kidney injury.The AUC of APACHEII scoring system was significantly higher than SOFA.CONCLUSIONSepsis patients are prone to acute kidney injury,and the prognosis is poor.There are many factors affecting acute kidney injury associated with sepsis,so clinical intervention should be strengthened.
OBJECTIVE To explore the clinical characteristics of sepsis complicated with acute kidney injury,analyze prognostic factors,and put forward the relevant intervention measures to improve its prognosis.METHODS The clinical data of 80 patients with sepsis from Nov.2014 to Jun.2017 were retrospectively analyzed.The medical records of patients were consulted,and clinical data were statistically analyzed.According to whether patients with acute kidney injury,patients were divided into sepsis with acute kidney injury group and sepsis without acute kidney injury group,the clinical indexes of the two groups were compared,and logistic multivariate regression analysis were carried out.The effects of SOFA and APACHEII scores on the prognosis of patients were compared by using the receiver operating curve(ROC curve).RESULTS Among 80 patients with sepsis,39(48.75%)were with acute kidney injury.Among the 80 patients,27 cases died accounting for 33.75%(27/80).There were 18 cases(46.15%)of death in sepsis with acute kidney injury group,which was significantly higher than 9 cases(21.95%)in sepsis without acute kidney injury group(χ2=5.231,P=0.024).Age,SOFA score and arterial blood pH were the main influencing factors of acute kidney injury in sepsis,and age,high SOFA score and low arterial blood pH were the independent risk factors of sepsis complicated with acute kidney injury.The AUC of APACHEII scoring system was significantly higher than SOFA.CONCLUSIONSepsis patients are prone to acute kidney injury,and the prognosis is poor.There are many factors affecting acute kidney injury associated with sepsis,so clinical intervention should be strengthened.
引文
[1]Gomez H,Ince C,De Backer D,et al.A unified theory of sepsis-induced acute kidney injury:inflammation,microcirculatory dysfunction,bioenergetics,and the tubular cell adaptation to injury[J].Shock,2014,41(1):3-11.
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[6]奚希相,李文放,马金苗,等.尿NGAL联合MEDS评分评估脓毒症合并急性肾损伤患者病情及预后[J].第二军医大学学报,2017,38(2):244-248.
[7]叶林,周发春.ICU感染性休克患者不同平均动脉压维持水平与急性肾损伤的发生及预后的关系[J].第三军医大学学报,2016,38(15):1781-1787.
[8]胡颖颖,何春雷,丁慧慧,等.脓毒症患者合并急性肾损伤的护理[J].中华现代护理杂志,2016,22(5):697-700.
[9]韩静,邱俏檬,吴斌,等.脓毒症并发急性肾损伤患者临床特点及预后因素分析[J].中华危重症医学杂志(电子版),2014,7(1):30-34.
[10]Yilmaz H,Cakmak M,Inan O,et al.Can neutrophil-lymphocyte ratio be independent risk factor for predicting acute kidney injury in patients with severe sepsis[J].Ren Fail,2015,37(2):225-229.
[11]Liu J,Abdel-Razek O,Liu Z,et al.Role of surfactant proteins A and D in sepsis-induced acute kidney injury[J].Shock,2015,43(1):31-38.
[12]丁毅,方强,吴晓梁,等.老年脓毒症患者并发急性肾损伤的相关影响因素及预后分析[J].中华老年医学杂志,2015,34(6):641-644.
[13]刘培,吴京秦,段美丽,等.脓毒症急性肾损伤患者肾功能恢复的影响因素[J].山东医药,2015,55(41):16-19.
[14]宗媛,王艳,张怡,等.脓毒症患者发生肾损伤的相关因素分析[J].安徽医药,2016,20(5):914-917.
[15]Heung M,Koyner JL.Entanglement of sepsis,chronic kidney disease,and other comorbidities in patients whodevelop acute kidney injury[J].Semin Nephrol,2015,35(1):23-37.
[16]Alobaidi R,Basu RK,Goldstein SL,et al.Sepsis-associated acute kidney injury[J].Semin Nephrol,2015,35(1):2-11.
[17]He L,Peng X,Zhu J,et al.Mangiferin attenuate sepsis-induced acute kidney injury via antioxidant and anti-inflammatory effects[J].Am J Nephrol,2014,40(5):441-450.
[18]凯塞尔·吐尔吾东,热娜·依马木.多器官功能障碍综合征并发急性肾损伤的相关因素分析[J].贵阳医学院学报,2015,40(7):754-755.
[2]Xu C,Chang A,Hack BK,et al.TNF-mediated damage to glomerular endothelium is an important determinant of acute kidney injury in sepsis[J].Kidney Int,2014,85(1):72-81.
[3]Cho E,Lee JH,Lim HJ,et al.Soluble CD25is increased in patients with sepsis-induced acute kidney injury[J].Nephrology(Carlton),2014,19(6):318-324.
[4]Serpa Neto A,Veelo DP,Peireira VG,et al.Fluid resuscitation with hydroxyethyl starches in patients with sepsis is associated with an increased incidence of acute kidney injury and use of renal replacement therapy:a systematic review and meta-analysis of the literature[J].J Crit Care,2014,29(1):185.e1-7.
[5]何捷,李达,严一核.尿肾损伤分子-1诊断脓毒症急性肾损伤的价值[J].实用医学杂志,2014,30(1):87-89.
[6]奚希相,李文放,马金苗,等.尿NGAL联合MEDS评分评估脓毒症合并急性肾损伤患者病情及预后[J].第二军医大学学报,2017,38(2):244-248.
[7]叶林,周发春.ICU感染性休克患者不同平均动脉压维持水平与急性肾损伤的发生及预后的关系[J].第三军医大学学报,2016,38(15):1781-1787.
[8]胡颖颖,何春雷,丁慧慧,等.脓毒症患者合并急性肾损伤的护理[J].中华现代护理杂志,2016,22(5):697-700.
[9]韩静,邱俏檬,吴斌,等.脓毒症并发急性肾损伤患者临床特点及预后因素分析[J].中华危重症医学杂志(电子版),2014,7(1):30-34.
[10]Yilmaz H,Cakmak M,Inan O,et al.Can neutrophil-lymphocyte ratio be independent risk factor for predicting acute kidney injury in patients with severe sepsis[J].Ren Fail,2015,37(2):225-229.
[11]Liu J,Abdel-Razek O,Liu Z,et al.Role of surfactant proteins A and D in sepsis-induced acute kidney injury[J].Shock,2015,43(1):31-38.
[12]丁毅,方强,吴晓梁,等.老年脓毒症患者并发急性肾损伤的相关影响因素及预后分析[J].中华老年医学杂志,2015,34(6):641-644.
[13]刘培,吴京秦,段美丽,等.脓毒症急性肾损伤患者肾功能恢复的影响因素[J].山东医药,2015,55(41):16-19.
[14]宗媛,王艳,张怡,等.脓毒症患者发生肾损伤的相关因素分析[J].安徽医药,2016,20(5):914-917.
[15]Heung M,Koyner JL.Entanglement of sepsis,chronic kidney disease,and other comorbidities in patients whodevelop acute kidney injury[J].Semin Nephrol,2015,35(1):23-37.
[16]Alobaidi R,Basu RK,Goldstein SL,et al.Sepsis-associated acute kidney injury[J].Semin Nephrol,2015,35(1):2-11.
[17]He L,Peng X,Zhu J,et al.Mangiferin attenuate sepsis-induced acute kidney injury via antioxidant and anti-inflammatory effects[J].Am J Nephrol,2014,40(5):441-450.
[18]凯塞尔·吐尔吾东,热娜·依马木.多器官功能障碍综合征并发急性肾损伤的相关因素分析[J].贵阳医学院学报,2015,40(7):754-755.