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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2020, Vol. 09 ›› Issue (05) : 202 -206. doi: 10.3877/cma.j.issn.2095-3216.2020.05.002

所属专题： 总编推荐； 文献；

论著

老年脓毒症相关急性肾损伤后肾功能恢复及危险因素分析
张洁1, 张麒2, 张瑞芹1,†()   
  1. 1. 100853　北京，解放军总医院第二医学中心肾脏病科，国家老年疾病临床医学研究中心
    2. 100853　北京，解放军总医院第二医学中心卫勤部，国家老年疾病临床医学研究中心
  • 收稿日期:2020-02-24 出版日期:2020-10-28
  • 通信作者: 张瑞芹

Renal function recovery and risk factors analysis of elderly sepsis-related acute kidney injury

Jie Zhang1, Qi Zhang2, Ruiqin Zhang1,†()   

  1. 1. Department of Nephrology; Second Medcal Center, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing 100853, China
    2. Department of Health Service; Second Medcal Center, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing 100853, China
  • Received:2020-02-24 Published:2020-10-28
  • Corresponding author: Ruiqin Zhang
  • About author:
    Corresponding author: Zhang Ruiqin, Email:
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引用本文：

张洁, 张麒, 张瑞芹. 老年脓毒症相关急性肾损伤后肾功能恢复及危险因素分析[J]. 中华肾病研究电子杂志, 2020, 09(05): 202-206.

Jie Zhang, Qi Zhang, Ruiqin Zhang. Renal function recovery and risk factors analysis of elderly sepsis-related acute kidney injury[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2020, 09(05): 202-206.

目的

了解老年脓毒症相关急性肾损伤(sepsis-associated acute kidney injury, SA-AKI)患者的肾功能恢复率、临床特点及危险因素。

方法

回顾性分析2018年1月至2019年12月就诊于解放军总医院国家老年疾病临床医学研究中心≥75岁的SA-AKI患者的临床资料。根据出院时肌酐(serum creatinine，Scr)恢复情况，患者分为恢复组(出院时Scr≤125%基线值)和未恢复组(出院时Scr>125%基线值)。AKI定义和诊断标准采用2012年改善全球肾脏病预后组织(Kidney Disease: Improving Global Outcomes，KDIGO)制定的标准。持续型AKI定义为AKI发生48 h时Scr无下降(>基线Scr水平)。

结果

192例患者中位年龄为87(84～90)岁，男性183例，占95.3%。患者出院时21.9%(42/192)患者肾功能未恢复，78.1%(150/192)肾功能恢复。肾功能恢复组与未恢复组相比，性别比例(P<0.05)、基线Scr(P<0.001)和基础eGFR(P<0.001)差异有统计学意义。肾功能未恢复组患者AKI确诊时Scr(P<0.05)、Scr峰值(P<0.001)水平较高，肾脏替代治疗(P<0.05)和机械通气(P<0.001)需要率明显增加，持续型AKI所占比例高(P<0.001)。多因素Logistic回归分析显示两组在基础eGFR(70～79: OR＝0.258，95%CI：0.088～0.757，P<0.05；80～89: OR＝0.132，95%CI：0.041～0.421，P＝0.001；≥90：OR＝0.096，95%CI：0.015～0.627，P＝0.014)、机械通气(OR＝6.715；95%CI：2.665～16.918；P<0.001)和持续型AKI(OR＝6.706；95%CI：2.741～16.404；P<0.001)等方面差异显著。

结论

高龄老年SA-AKI患者肾功能大多数可恢复，基础eGFR升高是高龄老年SA-AKI患者肾功能恢复的保护因素，机械通气和持续型AKI是高龄老年SA-AKI患者肾功能恢复的危险因素。

关键词: 脓毒症, 急性肾损伤, 老年, 肾功能, 危险因素
Objective

To understand the recovery rate of renal function, clinical features, and risk factors in elderly patients with sepsis-associated acute kidney injury (SA-AKI).

Methods

A retrospective analysis was made of the clinical data of SA-AKI patients who were no less than 75 years old from the Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, from January 2018 to December 2019. According to recovery of serum creatinine (Scr) at discharge, the patients were divided into recovery group (Scr≤125% baseline value at discharge), and non-recovery group (Scr>125% baseline value at discharge). AKI was defned according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Persistent AKI was defined as no decrease of Scr (>baseline value) at 48 hours after the occurrence of AKI.

Results

The 192 patients had a median age of 87 (84-90) years, and included 183 males (95.3%). At the time of discharge, the renal function was recovered in 78.1% (150/192) patients, and not recovered in 21.9%(42/192) patients. There were statistically significant differences between the recovery group and the non-recovery group in gender ratio (P<0.05), baseline Scr (P<0.01), and baseline eGFR (P<0.001). Compared with the recovery group, the non-recovery group showed higher Scr at diagnosis of AKI (P<0.05), higher peak Scr (P<0.001), higher rate of renal replacement therapy (P<0.05), higher rate of mechanical ventilation (P<0.001), and a higher proportion of persistent AKI (P<0.001). Multivariate logistic regression analysis revealed that there were statistically significant differences between the recovery group and the non-recovery group in baseline eGFR (70-79: OR=0.258, 95%CI: 0.088-0.757, P<0.05; 80-89: OR=0.132, 95%CI: 0.041-0.421, P=0.001; ≥90: OR=0.096, 95%CI: 0.015-0.627, P=0.014), in mechanical ventilation (OR=6.715, 95%CI: 2.665-16.918, P<0.001), and in persistent AKI (OR=6.706, 95%CI: 2.741-16.404, P<0.001).

Conclusion

The recovery rate of renal function in elderly patients with SA-AKI was 78%. The increased eGFR was a protective factor while mechanical ventilation and persistent AKI were risk factors for the recovery of the renal function.

Key words: Sepsis, Acute kidney injury, Elderly, Renal function, Risk factor
表1 肾功能恢复组与未恢复组患者的一般情况
项目 AKI患者(n＝192) 未恢复组(n＝42) 恢复组(n＝150) P值
年龄(岁) 87(84～90) 88(84～91) 87(84～90) 0.294
男性[例(%)] 183(95.3) 42(100.0) 141(94.0) 0.033
BMI(kg/m2) 23.5±3.4 24.2±3.7 23.3±3.3 0.123
基础疾病[例(%)]        
  冠心病 148(77.1) 32(76.2) 116(77.3) 0.876
  高血压 143(74.5) 31(73.8) 112(74.7) 0.910
  COPD 133(69.3) 28(66.7) 105(70.0) 0.679
  糖尿病 72(37.5) 12(28.6) 60(40.0) 0.176
基础肾功能        
  Scr(μmol/L) 76.0(63.0～84.8) 86.5(73.3～92.0) 73.5(62.0～82.0) <0.001
  eGFR[(ml/(min·1.73 m2)]       <0.001
    60～69 53(27.6) 24(57.1) 29(19.3)  
    70～79 63(32.8) 9(21.4) 54(36.0)  
    80～89 58(30.2) 7(16.7) 51(34.0)  
    ≥90 18(9.4) 2(4.8) 16(10.7)  
表2 肾功能恢复组与未恢复组患者的临床特征
临床特征 AKI患者(n＝192) 未恢复组(n＝42) 恢复组(n＝150) P值
AKI确诊时伴随情况        
  平均动脉压(mmHg) 81±14 80±10 82±15 0.592
  少尿[例(%)] 6(3.1) 0(0) 6(4.0) 0.082
  RRT [例(%)] 2(1.0) 2(4.8) 0(0) 0.013
  机械通气[例(%)] 56(29.2) 25(59.5) 31(20.7) <0.001
AKI确诊时        
  Scr(μmol/L) 124.4(112.6～141.0) 126.6(120.1～146.5) 124.0(110.8～139.1) 0.047
  Scr峰值(μmol/L) 134.1(115.7～160.0) 146.2(126.5～221.8) 128.3(112.5～149.5) <0.001
  BUN(mmol/L) 10.8(7.6～15.8) 10.0(6.7～16.6) 11.0(7.7～15.7) 0.394
  尿酸(μmol/L) 340.8(286.2～424.8) 374.7(261.3～448.3) 335.0(287.5～411.4) 0.402
  血清前白蛋白(mg/L) 189(150～230) 205(152～246) 188(149～230) 0.355
  血清白蛋白(g/L) 35.2±5.0 36.0±4.7 34.9±5.0 0.199
  血红蛋白(g/L) 118±20 119±20 117±21 0.582
AKI分期[例(%)]       0.606
  1期 117(60.9) 23(54.8) 94(62.7)  
  2期 46(24.0) 11(26.2) 35(23.3)  
  3期 29(15.1) 8(19.0) 21(14.0)  
持续性AKI[例(%)] 70(36.5) 32(76.2) 38(25.3) <0.001
表3 老年SA-AKI患者肾功能未恢复的多因素Logistic回归分析
影响因素 回归系数 OR值 95%CI P值
基础eGFR        
  60～69 - - - -
  70～79 -1.355 0.258 0.088～0.757 0.014
  80～89 -2.027 0.132 0.041～0.421 0.001
  ≥ 90 -2.343 0.096 0.015～0.627 0.014
机械通气 1.904 6.715 2.665～16.918 <0.001
持续性AKI 1.903 6.706 2.741～16.404 <0.001
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