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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2023, Vol. 12 ›› Issue (03) : 134 -138. doi: 10.3877/cma.j.issn.2095-3216.2023.03.003

论著

高龄急性肾损伤患者连续性肾脏替代治疗的预后及影响因素
于天宇, 杨悦†(), 陆海涛, 田志永, 李文歌   
  1. 100029　北京，中日友好医院肾病科
  • 收稿日期:2023-02-03 出版日期:2023-06-28
  • 通信作者: 杨悦
  • 基金资助:
    国家科技支撑计划课题(2015BAI12B06)

Prognosis and its influencing factors in elderly AKI patients after continuous renal replacement therapy

Tianyu Yu, Yue Yang†(), Haitao Lu, Zhiyong Tian, Wenge Li   

  1. Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China
  • Received:2023-02-03 Published:2023-06-28
  • Corresponding author: Yue Yang
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于天宇, 杨悦, 陆海涛, 田志永, 李文歌. 高龄急性肾损伤患者连续性肾脏替代治疗的预后及影响因素[J]. 中华肾病研究电子杂志, 2023, 12(03): 134-138.

Tianyu Yu, Yue Yang, Haitao Lu, Zhiyong Tian, Wenge Li. Prognosis and its influencing factors in elderly AKI patients after continuous renal replacement therapy[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(03): 134-138.

目的

探讨高龄老年急性肾损伤(AKI)患者连续性肾脏替代治疗(CRRT)后的预后及影响因素。

方法

回顾性分析中日友好医院肾病科2016年1月至2023年1月的≥80岁高龄AKI患者接受CRRT治疗90 d后的生存情况，及其治疗剂量、急性生理和慢性健康状况评估Ⅱ(APACHE Ⅱ)和序贯器官衰竭评估(SOFA)评分。

结果

43例年龄(91.3±6.6)岁的AKI患者CRRT 90 d后，生存12例、死亡31例，总死亡率72.1%。APACHE Ⅱ评分死亡患者(27.2±4.2)明显高于生存患者(24.0±5.0)(P<0.05)。CRRT治疗15 d、30 d和45 d的累积生存率分别为71.8%、56.8%和43.2%。Logistic回归分析显示APACHE Ⅱ评分和SOFA评分是患者预后的独立影响因素(P<0.05)。

结论

高龄AKI患者CRRT治疗后的死亡率随APACHE Ⅱ评分增高而升高。APACHE Ⅱ评分和SOFA评分是高龄AKI患者开始CRRT治疗和预后的影响因素。

关键词: 连续性肾脏替代治疗, 急性肾损伤, 高龄, 预后
Objective

To investigate the outcomes and influencing factors of elderly patients with acute kidney injury (AKI) after continuous renal replacement therapy (CRRT).

Methods

Data of elderly AKI patients aged≥80 were collected who received CRRT treatment for 90 days in the hospital from January 2016 to January 2023. Analysis was performed in their survival status, treatment dose, and scores of acute physiological and chronic health evaluation Ⅱ(APACHE Ⅱ) and sequential organ failure assessment (SOFA).

Results

After 90 days of CRRT in 43 AKI patients aged (91.3±6.6), 12 patients survived and 31 died, with a total mortality rate of 72.1%. The APACHE Ⅱ scores of the dead patients (27.2±4.2) were significantly higher than those of the surviving patients (24.0±5.0) (P<0.05). The cumulative survival rates of CRRT treatment for 15 days, 30 days, and 45 days were 71.8%, 56.8%, and 43.2%, respectively. Logistic regression analysis showed that APACHE Ⅱ score and SOFA score were independent influencing factors to affect the prognosis of the patients (P<0.05).

Conclusion

The mortality rate of the elderly AKI patients after the CRRT treatment increased with the increase of APACHE Ⅱ score. The APACHE Ⅱ score and SOFA score were the influencing factors in the initiation of CRRT treatment and prognosis for the elderly AKI patients.

Key words: Continuous renal replacement therapy, Acute kidney injury, Elderly, Prognosis
表1 43例高龄急性肾损伤患者接受连续性肾脏替代治疗时的临床基线资料
项目 基线数值
年龄(岁) 91.3±6.6
男性[例(%)] 35(81.4)
血肌酐(μmol/L) 245.0(179.8, 333.7)
尿素氮(mmol/L) 28.1(20.3, 40.1)
碳酸氢根离子(mmol/L) 24.7±7.3
血白蛋白(g/L) 33.0(31.0, 36.0)
血钾(mmol/L) 4.5±0.8
血钙(mmol/L) 2.1(1.9, 2.3)
血磷(mmol/)L 1.5±0.7
血红蛋白(g/L) 85.6±16.3
总胆红素(mmol/L) 7.2(4.2, 13.7)
APACHE Ⅱ评分(分) 26.3±4.6
SOFA评分(分) 9.9±2.4
机械通气[例(%)] 30(69.8)
合并症[例(%)]  
呼吸衰竭 25(55.8)
心力衰竭 18(41.9)
恶性肿瘤 10(23.3)
表2 APACHE Ⅱ评分比较
APACHE Ⅱ评分(分) 生存患者(n＝12) 死亡患者(n＝31) 死亡风险系数 实际死亡率
≤23 6 7 0.22±0.08 53.84
24~30 5 15 0.37±0.06 75.00
≥30 1 9 0.57±0.09 90.00
表3 治疗剂量对连续性肾脏替代治疗90 d预后的影响
不同预后结局 例数 治疗剂量[ml/(kg·h)]
<30 30~35 >35
生存 12 3例 4例 5例
死亡 31 11例 8例 12例
χ2值 0.578      
P值 0.834      
图1 治疗30 d及90 d高龄急性肾损伤患者生存情况
表4 接受连续性肾脏替代治疗90 d后的高龄急性肾损伤患者的回归分析
临床项目 单因素分析 多因素分析
OR值(95%CI) P值 OR值(95%CI) P值
年龄(岁) 0.936(0.840，1.043) 0.233 0.850 (0.712，1.015) 0.730
男性 0.296(0.060，1.460) 0.296 － －
血肌酐(μmol/L) 1.005(1.000，1.011) 0.161 － －
尿素氮(mmol/L) 1.042(0.980，1.108) 0.189 － －
碳酸氢根离子(mmol/L) 1.033(0.940，1.137) 0.498 － －
血白蛋白(g/L) 0.979 (0.821，1.168) 0.816 － －
血钾(mmol/L) 0.566(0.243，1.319) 0.187 － －
血钙(mmol/L) 2.131(0.163，27.936) 0.564 － －
血磷(mmol/L) 0.870(0.314，2.409) 0.788 － －
血红蛋白(g/L) 1.007(0.966，1.050) 0.741 － －
APACHE Ⅱ评分(分) 1.253(1.044，1.505) 0.016 1.582(1.066，2.346) 0.023
SOFA评分(分) 1.732(1.137，2.639) 0.011 2.173(1.066，2.346) 0.012
机械通气[例(%)] 2.054(0.506，8.340) 0.314 － －
治疗剂量[ml/(kg·h)] 0.982(0.866，1.113) 0.774 1.228(0.871，1.732) 0.241
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