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中华肾病研究电子杂志 ›› 2025, Vol. 14 ›› Issue (05) : 248 -253. doi: 10.3877/cma.j.issn.2095-3216.2025.05.002

论著

脓毒症相关急性肾损伤患者临床特点及90天预后影响因素分析
李恺1, 敖强国2, 陶亚茹1, 李青霖3,()   
  1. 1100120 北京,解放军总医院京中医疗区黄寺门诊部
    2100853 北京,解放军总医院第二医学中心肾脏病科
    3100853 北京,解放军总医院肾脏病医学部,肾脏疾病全国重点实验室,国家慢性肾病临床医学研究中心,重症肾脏疾病器械与中西医药物研发北京市重点实验室、数智中医泛血管疾病防治北京市重点实验室、国家中医药管理局高水平中医药重点学科(zyyzdxk-2023310)
  • 收稿日期:2024-10-31 出版日期:2025-10-28
  • 通信作者: 李青霖
  • 基金资助:
    国家重点研发计划(2023YFC3605500,2023YFC3605501)

Analysis on clinical characteristics and influencing factors of 90-day outcome in patients with sepsis-associated acute kidney injury

Kai Li1, Qiangguo Ao2, Yaru Tao1, Qinglin Li3,()   

  1. 1Huangsi Outpatient Department, Jingzhong Medical District of Chinese PLA General Hospital, Beijing 100120
    2Department of Nephrology, Second Medical Centre of Chinese PLA General Hospital, Beijing 100853
    3Department of Nephrology, Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Medical Devices and Integrated Traditional Chinese and Western Drug Development for Severe Kidney Diseases, Beijing Key Laboratory of Digital Intelligent TCM for Prevention and Treatment of Pan-vascular Diseases, Key Disciplines of National Administration of Traditional Chinese Medicine (zyyzdxk-2023310), Beijing 100853; China
  • Received:2024-10-31 Published:2025-10-28
  • Corresponding author: Qinglin Li
引用本文:

李恺, 敖强国, 陶亚茹, 李青霖. 脓毒症相关急性肾损伤患者临床特点及90天预后影响因素分析[J/OL]. 中华肾病研究电子杂志, 2025, 14(05): 248-253.

Kai Li, Qiangguo Ao, Yaru Tao, Qinglin Li. Analysis on clinical characteristics and influencing factors of 90-day outcome in patients with sepsis-associated acute kidney injury[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2025, 14(05): 248-253.

目的

探讨脓毒症相关急性肾损伤(sepsis-associated AKI,SA-AKI)患者的临床特点及其90 d预后影响因素。

方法

回顾性分析2018年1月至2022年12月就诊于解放军总医院ICU的SA-AKI患者。根据AKI发生后90 d时生存情况,将患者分为死亡组和存活组。采用多因素Cox回归模型方法分析预后影响因素。

结果

共纳入SA-AKI患者304例,中位年龄61岁(48~68岁),其中男性208例(68.4%)。根据KDIGO分期标准,AKI 1期44例(14.5%),2期76例(25.0%),3期184例(60.5%)。根据AKI后48 h肾功能恢复情况,短暂性AKI有44例(14.5%),持续性AKI有260例(85.5%)。共有244例(80.3%)患者接受了CRRT。至AKI发生90 d时共有116例患者死亡(38.2%)。与死亡组相比,存活组平均动脉压[(82±11) mmHg比(78±15) mmHg,P=0.005]和血清白蛋白[(29.4±6.4) g/L比(27.6±5.2) g/L,P=0.013]均增高,血清肌酐(135.5 μmol/L比159.1 μmol/L,P=0.013)、血尿素氮(12.5 mmol/L比13.8 mmol/L,P=0.009)和血乳酸(1.8 mmol/L比4.1 mmol/L,P<0.01)均较低。此外,存活组出现少尿(21.3%比37.9%,P=0.002)、持续性AKI(79.3%比89.4%, P=0.016)、使用升压药(68.1%比86.2%,P<0.01)和接受CRRT(74.5%比89.7%,P=0.001)的比例也低于死亡组。多因素Cox回归模型分析显示,年龄(HR=1.034,95%CI:1.020~1.048,P<0.01)、体质量指数(HR=0.908,95%CI:0.860~0.958,P<0.01)、平均动脉压(HR=0.968,95%CI:0.953~0.984,P<0.01)、血乳酸(HR=1.158,95%CI:1.099~1.220,P<0.01)和CRRT(HR=2.757,95%CI:1.450~5.239,P=0.002)是影响SA-AKI患者90 d预后的独立影响因素。

结论

SA-AKI患者90 d病死率为38%,年龄、体质量指数、平均动脉压、血乳酸和CRRT是其独立影响因素。

Objective

To explore the clinical characteristics and influencing factors of 90-day outcome in patients with sepsis-associated acute kidney.

Methods

A retrospective analysis was conducted on patients with SA-AKI who were admitted to the ICU of the Chinese PLA General Hospital from January 2018 to December 2022. The patients were divided into a deceased group and a survival group based on their survival status at 90 days after the occurrence of AKI. The multi-factor Cox model regression method was used to analyze the outcome-influencing factors.

Results

A total of 304 patients with SA-AKI were included, with a median age of 61 years (range 48-68 years), including 208 males (68.4%). According to the KDIGO staging criteria, there were 44 patients (14.5%) with AKI stage 1, 76 patients (25.0%) with AKI stage 2, and 184 patients (60.5%) with AKI stage 3. According to the recovery status of renal function within 48 hours after AKI, 44 patients (14.5%) had transient AKI, and 260 patients (85.5%) had persistent AKI. And 244 patients (80.3%) underwent continuous renal replacement therapy (CRRT). By 90 days after AKI onset, 116 patients (38.2%) had died. Compared with the deceased group, the survival group had higher levels of mean arterial pressure [(82±11) mmHg vs. (78±15) mmHg, P=0.005] and serum albumin [(29.4±6.4) g/L vs. (27.6±5.2) g/L, P=0.013], and lower levels of serum creatinine (135.5 μmol/L vs. 159.1 μmol/L, P=0.013), blood urea nitrogen (12.5 mmol/L vs. 13.8 mmol/L, P=0.009), and blood lactate (1.8 mmol/L vs. 4.1 mmol/L, P<0.01). Furthermore, the survival group exhibited lower rates of oliguria (21.3% vs. 37.9%, P=0.002), persistent AKI (79.3% vs. 89.4%, P=0.016), administration of vasopressors (68.1% vs. 86.2%, P<0.01), and receipt of CRRT (74.5% vs. 89.7%, P=0.001) compared to the deceased group. Multivariate Cox regression analysis showed that age (HR=1.034, 95%CI: 1.020-1.048, P<0.01), body mass index (HR=0.908, 95%CI: 0.860-0.958, P<0.01), mean arterial pressure (HR=0.968, 95%CI: 0.953-0.984, P<0.01), blood lactate (HR=1.158, 95%CI: 1.099-1.220, P<0.01), and CRRT (HR=2.757, 95%CI: 1.450-5.239, P=0.002) were independent factors affecting the 90-day outcome of the SA-AKI patients.

Conclusions

The 90-day mortality rate of the SA-AKI patients was 38% while its independent influencing factors included age, body mass index, mean arterial pressure, blood lactate, and CRRT.

表1 两组脓毒症相关急性肾损伤患者的一般情况与临床特征
项目 纳入患者(304例) 存活组(188例) 死亡组(116例) P
年龄(岁) 61.0 (48.0,68.0) 58.0 (44.0,67.0) 66.0 (53.0,75.0) <0.001
男性[例(%)] 208 (68.4) 136 (72.3) 72 (62.1) 0.061
BMI (kg/m2) 24.6±4.1 25.2±4.4 23.7±3.5 0.001
基础疾病[例(%)]        
高血压 108 (35.5) 72 (38.3) 36 (31.0) 0.199
糖尿病 80 (26.3) 52 (27.7) 28 (24.1) 0.498
冠心病 64 (21.1) 48 (25.5) 16 (13.8) 0.015
基线Scr (μmol/L) 70.0 (61.0,78.0) 70.0 (60.0,76.0) 70.0 (63.0,81.0) 0.078
SA-AKI确诊时伴随情况        
平均动脉压(mmHg) 80±12 82±11 78±15 0.005
中心静脉压(cmH2O) 10 (8,12) 10 (8,12) 9 (8,14) 0.905
少尿[例(%)] 84 (27.6) 40 (21.3) 44 (37.9) 0.002
机械通气[例(%)] 38 (77.6) 9 (90.0) 29 (74.4) 0.257
SA-AKI确诊时危重评分        
APACHEⅡ评分 21±7 21±7 22±9 0.264
SOFA评分 14 (10,15) 14 (10,15) 14 (9,15) 0.283
SA-AKI确诊时实验室指标        
Scr (μmol/L) 152.7 (117.9,207.7) 135.5 (113.2,194.3) 159.1 (123.8,214.6) 0.013
Scr峰值(μmol/L) 244.8 (157.1,360.5) 228.1 (156.8,343.0) 250.6 (157.9,381.4) 0.675
血尿素氮(mmol/L) 13.0 (9.9,17.1) 12.5 (8.6,16.0) 13.8 (10.6,18.7) 0.009
血尿酸(μmol/L) 362.1 (300.3,497.5) 396.0 (306.2,497.5) 339.8 (286.3,491.3) 0.096
血清白蛋白(g/L) 28.7±6.0 29.4±6.4 27.6±5.2 0.013
血红蛋白(g/L) 100±25 102±26 98±21 0.216
血乳酸(mmol/L) 2.6 (1.4,4.8) 1.8 (1.1,3.4) 4.1 (2.8,6.0) <0.001
动脉氧分压(mmHg) 98.0 (71.0,130.0) 92.0 (73.0,132.0) 107.0 (68.0,122.0) 0.138
动脉二氧化碳分压(mmHg) 34.0 (29.0,39.0) 34.0 (30.0,39.0) 34.0 (29.0,39.0) 0.763
氧合指数(mmHg) 218.0 (157.3,306.8) 218.0 (161.0,316.0) 213.0 (154.0,280.0) 0.623
SA-AKI分期[例(%)]       0.714
1期 44 (14.5) 28 (14.9) 16 (13.8)  
2期 76 (25.0) 44 (23.4) 32 (27.6)  
3期 184 (60.5) 116 (61.7) 68 (58.4)  
SA-AKI确诊时治疗[例(%)]        
升压药 228 (75.0) 128 (68.1) 100 (86.2) <0.001
CRRT 244 (80.3) 140 (74.5) 104 (89.7) 0.001
持续性SA-AKI 260 (85.5) 92 (79.3) 168 (89.4) 0.016
表2 影响脓毒症相关急性肾损伤患者90 d生存的多因素Cox回归模型分析
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