Clinical characteristics and influencing factors of prognosis in patients with sepsis complicated with acute renal injury
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摘要: 目的 观察脓毒症并发急性肾损伤患者临床特征，并分析其预后的影响因素。方法 收集2019年1月-2021年12月我院急诊科312例脓毒症患者的临床资料，将其中发生急性肾损伤的136例患者纳入发生组，将未发生急性肾损伤的176例患者纳入未发生组。观察两组患者临床特征，并分析脓毒症并发急性肾损伤患者预后的影响因素。结果 发生组和未发生组序贯器官衰竭(SOFA)评分、入住ICU时间、总住院时间、机械通气支持率、糖尿病发生率之间进行比较，差异有统计学意义(P< 0.05)。随访1个月，136例脓毒症并发急性肾损伤患者中预后不良78例(57.35%)，预后良好58例(42.65%)；176例单纯脓毒症患者中预后不良33例(18.75%)，预后良好143例(81.25%)；预后不良组SOFA评分、Scr、连续性肾替代治疗、机械通气支持与预后良好组比较，差异有统计学意义(P< 0.05)；经COX回归分析结果显示，SOFA评分、Scr、机械通气支持是脓毒症并发急性肾损伤患者预后的危险因素(HR> 1，P< 0.05)；连续性肾替代治疗是脓毒症并发急性肾损伤患者预后的保护因素(HR< 1，P< 0.05)。结论 脓毒症并发急性肾损伤患者以高SOFA评分、机械通气支持率、糖尿病发生率以及入住ICU时间、总住院时间长为主要临床特征，SOFA评分、Scr、机械通气支持是脓毒症并发急性肾损伤患者预后的危险因素，连续性肾替代治疗是其保护因素。Abstract: Objective To observe the clinical characteristics of patients with sepsis complicated with acute renal injury, and to analyze the influencing factors of prognosis.Methods The clinical data of 312 patients with sepsis in the hospital from January 2019 to December 2021 were collected. One hundred and thirty-six patients with acute renal injury were included in the occurrence group, and 176 patients without acute renal injury were included in the non-occurrence group. The clinical characteristics of patients in the two groups were observed, and the influencing factors of prognosis in patients with sepsis complicated with acute renal injury were analyzed.Results Compared the score of sequential organ failure(SOFA), the time of intensive care unit(ICU), total hospitalization time, mechanical ventilation support and diabetes between the occurrence group and the non occurrence group, the difference was statistically significant(P< 0.05). Among 136 patients with sepsis complicated with acute renal injury, 78 cases(57.35%) had a poor prognosis and 58 cases(42.65%) had a good prognosis. Among 176 patients with simple sepsis, 33 cases(18.75%) had a poor prognosis and 143 cases(81.25%) had a good prognosis; compared SOFA score, Scr, continuous renal replacement therapy and mechanical ventilation support between the poor prognosis group and the good prognosis group, the difference was statistically significant(P< 0.05); through Cox regression analysis, the result showed that SOFA score, Scr and mechanical ventilation support were the risk factors of prognosis in patients with sepsis complicated with acute renal injury(HR> 1,P< 0.05); continuous renal replacement therapy was a protective factor for the prognosis of patients with sepsis complicated with acute renal injury(HR< 1,P< 0.05).Conclusion The main clinical features of patients with sepsis complicated with acute kidney injury are high SOFA score, mechanical ventilation support rate, diabetes incidence, and ICU duration and length of hospitalization time. SOFA score, Scr and mechanical ventilation support are the risk factors of prognosis in patients with sepsis complicated with acute renal injury, and continuous renal replacement therapy is its protective factor.
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Key words:
- sepsis /
- acute renal injury /
- clinical features /
- prognosis
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表 1 脓毒症并发与未并发急性肾损伤患者临床特征比较
例(%)，X±S 临床特征 发生组(136例) 未发生组(176例) χ2/t P 性别 0.286 0.593 男 76(55.88) 93(52.84) 女 60(44.12) 83(47.16) 年龄/岁 70.28±4.76 69.78±4.53 0.947 0.344 SOFA评分/分 10.66±3.47 8.20±3.14 6.550 < 0.001 APACHE Ⅱ评分/分 24.18±4.15 24.58±4.29 0.834 0.405 住ICU时间/d 11.53±2.76 8.15±2.31 11.562 < 0.001 总住院时间/d 15.26±3.18 12.94±2.95 6.060 < 0.001 机械通气支持 10.180 0.001 使用 91(66.91) 86(48.86) 未使用 45(33.09) 90(51.14) 糖尿病 4.300 0.038 有 22(16.18) 15(10.80) 无 114(83.82) 161(89.20) 高血压 0.297 0.586 有 73(53.68) 89(50.57) 无 63(46.32) 87(49.43) 慢性心力衰竭 0.186 0.667 有 25(18.38) 22(11.93) 无 111(81.62) 154(88.07) 血管活性药物使用情况 0.045 0.833 使用 71(52.21) 94(53.41) 未使用 65(47.79) 82(46.59) 肾毒性药物使用 8.153 0.004 使用 33(24.26) 21(11.93) 未使用 103(75.74) 155(88.07) 创伤 6.840 0.009 有 42(30.88) 32(18.18) 无 94(69.12) 144(81.82) 乳酸/(mmol·L-1) 2.81±0.83 2.08±0.61 8.953 < 0.001 白蛋白/(g·dL-1) 2.68±0.91 3.06±1.02 3.419 0.001 降钙素原/(ng·L-1) 21.36±4.86 16.38±4.25 9.638 < 0.001 
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表 2 预后不良与预后良好组患者临床特征比较
例(%)，X±S 临床特征 预后不良组(78例) 预后良好组(58例) χ2/t P 性别 0.021 0.886 男 44(56.41) 32(55.17) 女 34(43.59) 26(44.83) 年龄/岁 70.70±4.81 69.72±4.52 1.191 0.236 SOFA评分/分 11.87±3.47 9.03±3.19 4.893 < 0.001 APACHE Ⅱ评分/分 24.36±4.09 23.94±3.96 0.612 0.542 Scr/(μmol·L-1) 219.45±42.39 196.84±37.62 3.225 0.002 入住ICU时间/d 11.66±2.78 11.36±2.60 0.623 0.535 总住院时间/d 15.02±2.99 15.58±3.02 1.070 0.286 连续性肾替代治疗 13.218 < 0.001 使用 24(30.77) 36(62.07) 未使用 54(69.23) 22(37.93) 机械通气支持 4.582 0.032 使用 58(74.36) 33(56.90) 未使用 20(25.64) 25(43.10) 血管活性药物使用情况 0.197 0.657 使用 42(53.85) 29(50.00) 未使用 36(46.15) 29(50.00)
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表 3 主要自变量说明
自变量 变量说明 赋值情况 SOFA评分 连续变量 原值输入 Scr 连续变量 原值输入 连续性肾替代治疗 分类变量 1=“使用”, 2=“未使用” 机械通气支持 分类变量 1=“使用”, 2=“未使用”
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表 4 脓毒症并发急性肾损伤患者预后COX回归分析
项目 β SE Wald χ2 P HR 95%CI SOFA评分 0.131 0.034 15.208 < 0.001 1.141 1.068~1.218 Scr 0.009 0.003 9.964 0.002 1.009 1.003~1.015 连续性肾替代治疗 -1.412 0.272 26.878 < 0.001 0.244 0.143~0.416 机械通气支持 1.138 0.287 15.719 < 0.001 3.119 1.778~5.474
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