摘要
目的分析老年重症肺炎患者并发急性肾损伤（acate kidney injury,AKI）的发病情况及危险因素。方法收集海军总医院呼吸重症监护病房2013年7月1日至2015年2月28日住院的老年重症肺炎患者资料,以改善全球肾脏病预后组织（KDIGO）推荐的AKI定义筛选出AKI患者,比较AKI患者、非AKI患者的临床资料及其预后,采用logistic回归分析AKI的危险因素。结果入选的138例重症肺炎患者中87例（63%）发生AKI,其中AKI 1期41例（29.7%）,AKI 2期23例（16.7%）,AKI 3期23例（16.7%）。AKI组的住院期间死亡率明显较非AKI组高（P〈0.001）,AKI的分级越高,死亡的风险增加（P〈0.001）。两组住院时间差异无统计学意义（P=0.40）。多因素二分类logistic回归分析显示,慢性肾脏疾病史[相对比值比（OR）=65.759,95%可信区间（CI）：6.555~659.661,P〈0.001]、机械通气史（OR=6.165,95%CI：2.137~17.788,P=0.001）、APACHE-II评分（OR=1.192,95%CI：1.070~1.329,P=0.001）、肾外器官衰竭数（OR=2.918,95%CI：1.261~6.751,P=0.012）是AKI发生的独立危险因素。结论老年重症肺炎住院期间发生AKI的风险高,肾损伤程度重,预后差。慢性肾脏疾病史、机械通气史、APACHEⅡ评分、肾外器官衰竭数目是罹患AKI的独立危险因素。
Objective To investigate the prevalence and risk factors of acute kidney injury（AKI） in elderly patients with severe pneumonia in order to better understand and prevent AKI. Methods All elderly patients with severe pneumonia hospitalized in the respiratory intensive care unit（RICU） of the Navy General Hospital during July of 2013 to February of 2015 were included. Improving Global Outcomes（KDIGO） clinical practice guideline for AKI was used to diagnosis AKI. The clinical characteristics and prognosis were retrospectively compared between the AKI and the no AKI group. Logistic regression analysis was used to investigate the risk factors of AKI in these patients. Results A total of138 patients were recruited. 63% of these patients had AKI, of which 41（29.7%） were stage 1 AKI, 23（16.7%） were stage2 AKI, 23（16.7%） were stage 3 AKI. The proportions of mortality increased with the increased severity of AKI（P〈0.001）, however, the length of RICU stay between groups did not show statistically significant differences（P = 0.40）. Multivariate logistic regression analysis showed chronic kidney disease（OR=65.759, 95%CI：6.555~659.661, P〈0.001）, mechanical ventilation（OR=6.165, 95% CI：2.137~17.788, P = 0.001）, APACHEⅡscores（OR=1.192, 95% CI：1.070~1.329,P = 0.001）, the number of extra-renal organ failures（OR=2.918, 95%CI=1.261~6.751, P = 0.012） were independent risk factors for AKI incidence. Conclusion Elderly patients with severe pneumonia are more prone to have severe AKI,which usually predicts poor prognosis. Independent risk factors for AKI include chronic kidney disease, mechanical ventilation, APACHEⅡ score and the number of extra-renal organ failures.
出处
《北京医学》
CAS
2016年第2期97-100,共4页
Beijing Medical Journal
关键词
老年
重症肺炎
急性肾损伤
危险因素
预后
Elderly
Severe pneumonia
Acute kidney injury（AKI）
Risk factors
Prognosis
