非手术老年住院患者合并急性肾损伤相关危险因素及预后分析

目的 分析非手术老年住院患者合并急性肾损伤（acute kidney injury,AKI）的相关危险因素及预后,以提高临床工作者对老年患者发生AKI的警惕性.方法 回顾性分析2012年5月至2013年5月入住武警北京总队医院的非手术老年住院患者的临床资料,应用多因素Logistic回归分析AKI发生的相关危险因素,并对各组患者的预后进行对比分析.结果 1 206例非手术老年住院患者中,共有112例老年患者合并AKI,AKI发病率为9.3％.其中AKIⅠ级73例,Ⅱ级17例,Ⅲ级22例.多因素Logistic回归分析显示合并2种及以上慢性基础疾病、急性感染、低血容量、应用肾毒性药物、血尿酸升高是AKI发生的危险因素（P＜0.05）.AKI组住院病死率（25.0％ vs 8.5％,P＜0.01）、平均住院时间[（26.0±5.9）d vs （20.5±5.2）d,P＜0.01]均显著高于未合并AKI组;AKI分级与患者的住院病死率（r=0.603,P＜0.01）,平均住院时间（r=0.561,P＜0.01）呈显著正相关关系.结论 合并超过2种慢性基础疾病、急性感染、低血容量、应用肾毒性药物、血尿酸升高是非手术老年住院患者发生AKI的独立危险因素;合并AKI的非手术老年住院患者预后差,控制慢性基础疾病,有效防治感染,纠正低血容量,减少肾毒性药物的应用,降低血尿酸是减少AKI发生的重要措施.

Risk factors and clinical outcomes of acute kidney injury in non-surgical hospitalized elderly patients

Objective To investigate the risk factors and clinical outcomes of acute kidney injury （AKI） in non surgical hospitalized elderly patients.Methods A case control retrospective study was carried out in Armed Police Beijing Corps Hospital between May 2012 and May 2013.The clinical data of all non-surgical hospitalized elderly patients were collected.The incidence,risk factors and clinical outcomes for AKI in non-surgical hospitalized elderly patients were analyzed.Results A total of 1206 non-surgical hospitalized elderly patients were enrolled in this study.The overall incidence of AKI was 9.3 %.Multivariate logistic regression analysis identified more than 2 comorbidities,infection,hypovolemia,nephrotoxic drugs and serum uric acid as risk factors for AKI.In-hospital mortality rate in non-surgical hospitalized elderly patients with AKI was higher than that without AKI （25.0% vs 8.5%,P〈0.01）.The mean hospitalization time in non-surgical hospitalized elderly patients with AKIwas longer than that without AKI （26.0 ± 5.9 days vs 20.5 ± 5.2 days,P〈0.01）.The severity of AKI was significantly associated with poor clinical outcomes.Conclusions The risk factors of AKI in non-surgical hospitalized elderly patients included more than 2 comorbidities,infection,hypovolemia,nephrotoxic drugs and serum uric acid.The severity of AKI was significantly associated with poor clinical outcomes of non-surgical hospitalized elderly patients.