脓毒症合并急性肾损伤患者发病及预后的多因素分析

目的 探讨影响脓毒症合并急性肾损伤(AKI)患者发病及预后的相关危险因素.方法 收集我院2000年2月至2010年3月脓毒症合并AKI患者的临床资料,同期非脓毒症合并AKI患者作为对照组,计算两组APACHEⅢ评分和ATN-ISI积分,主要以多因素Logistic回归分析脓毒症合并AKI组患者的临床特点、发病及预后的相关危险因素.结果 (1)全部患者病死率为23.3%,脓毒症合并AKI患者病死率为44.6%.(2)D-二聚体浓度随着器官衰竭数的增加而增高(r=0.356,P=0.019),患者病死率随着器官衰竭数的增加而增高(r=0.545,P＜0.01),但D-二聚体与预后没有相关性(r=0.277,P=0.072).(3)多因素Logistic回归分析提示:D-二聚体(＞2.2mg/L)、是否需要血管活性药物支持、活化部分凝血活酶时间(APTT)(＞50 s)是影响脓毒症合并AKI患者发病的相关危险因素;APACHEⅢ评分(＞60)、脏器衰竭数、是否需要机械通气支持是脓毒症合并AKI患者预后的相关危险因素.结论 (1)D-二聚体(＞2.2 mg/L)、是否需要血管活性药物支持、APTT＞50 s是脓毒症合并AKI患者发病的相关危险因素;APACHEⅢ评分＞60、脏器衰竭数、是否需要机械通气支持是脓毒症合并AKI患者预后的相关危险因素.(2)脓毒症患者血D-二聚体的浓度升高,预示着脓毒症患者发生AKI的概率增加,但D-二聚体在判断脓毒症合并AKI患者的预后上有一定的局限性.

Abstract：

Objective To investigate the risk factors of morbidity and prognosis in patients with acute kidney injury(AKI)due to sepsis.Methods A case-control retrospective study was carried out in AKI patients with/without sepsis from February 2000.to March 2010.APACHE Ⅲ and ATN-ISI were calculated.Multivariate logistic regression analysis was used to explore the clinical data and the risk factors of morbidity and prognosis in patients with septic AKI.Results (1)The overall mortality rate was 23.3%and the mortality rate of septic AKI patients 44.6%.(2)With no correlation with the level of D-dimer(r=0.356,P=0.019),the number of failed organs was positively correlated with the mortality rate in septic AKI patients(r=0.545,P＜0.01).(3)As demonstrated by multivariate analysis,D-dimer(＞ 2.2mg/L),supports of vasoactive agents,APTT(activated partial thromboplastin time)(＞ 50 s)were the pathogenetic risk factors for septic AKI patients;APACHE Ⅲ score(＞60),the number of fai1ed organs,supports of mechanical ventilation were the prognostic risk factors for septic AKI patients.Conclusion sThe pathogenetic risk factors of septic AKI patients are D-dimer(＞ 2.2 mg/L),supports of vasoactive agents and APTT(＞ 50 s);APACHE Ⅲ score(＞ 60),the number of failed organs and supports of mechanical ventilation are the prognostic risk factors for septic AKI patents.D-dimer may predict the morbidity of septic AKI patients,but it can not predict their prognoses.

A multiplicity of morbidity and prognostic factors in patients with septic and acute kidney injury

Objective To investigate the risk factors of morbidity and prognosis in patients with acute kidney injury(AKI)due to sepsis.Methods A case-control retrospective study was carried out in AKI patients with/without sepsis from February 2000.to March 2010.APACHE Ⅲ and ATN-ISI were calculated.Multivariate logistic regression analysis was used to explore the clinical data and the risk factors of morbidity and prognosis in patients with septic AKI.Results (1)The overall mortality rate was 23.3%and the mortality rate of septic AKI patients 44.6%.(2)With no correlation with the level of D-dimer(r=0.356,P=0.019),the number of failed organs was positively correlated with the mortality rate in septic AKI patients(r=0.545,P＜0.01).(3)As demonstrated by multivariate analysis,D-dimer(＞ 2.2mg/L),supports of vasoactive agents,APTT(activated partial thromboplastin time)(＞ 50 s)were the pathogenetic risk factors for septic AKI patients;APACHE Ⅲ score(＞60),the number of fai1ed organs,supports of mechanical ventilation were the prognostic risk factors for septic AKI patients.Conclusion sThe pathogenetic risk factors of septic AKI patients are D-dimer(＞ 2.2 mg/L),supports of vasoactive agents and APTT(＞ 50 s);APACHE Ⅲ score(＞ 60),the number of failed organs and supports of mechanical ventilation are the prognostic risk factors for septic AKI patents.D-dimer may predict the morbidity of septic AKI patients,but it can not predict their prognoses.