ICU内急性肾损伤患者的预后指标分析

目的 通过分析重症医学科(intensive care uint,ICU)内急性肾损伤(acute kidney injury,AKI)患者高病死率的影响因素.筛选与其相关的临床预后指标.方法 回顾性分析2008年3月至2009年8月在西安交通大学第二附属医院和中南大学湘雅医院ICU内收治的符合急性肾损伤诊断标准患者的临床资料,排除ICU未满24 h死亡患者、既往慢性肾脏病史及资料不完整的患者,按60 d生存状态将患者分为存活组和病死组,统计其性别,年龄、慢性疾病史、24 h内相关临床化验指标(血常规、血气分析、肝肾功能、血清胱抑素C浓度,血电解质等)的最差值,并对其进行急性病理生理学和慢性健康评价(APACHE)Ⅱ评分及确诊后60 d病死率.采用t检验、χ~2检验行两组问变量的差异比较,再应用单因素Logistic回归分析,计算比值比(OR)和95%可信区间(CI),并对筛选出的危险凶素进行多因素Logistic 回归分析各种因素与病死率之间的关系.结果 纳入病例98例,男60例,女38例,年龄19～89岁,(52.4 ±16.1)岁;到确诊后60 d为止,死亡34例,死亡率34.7%.病死组患者A-PACHEU评分(17.4±4.3)分高于存活组(14.2±4.8)分,P＜0.05.血清胱抑素(Cystatin C)＞1.3 ms/L的AKI患者死亡率为50%(24/48),高于血清Cystatin C＜1.3 mg/L的患者(20%,10/50;P＜0.05).单因素分析显示,器官衰竭数目t≥2个,少尿,APACHEⅡ＞15分,Cystatin C＞1.3 mg/L、Cystatin C＞1.3mg/L+APACHEⅡ＞15分与AKI患者死亡率相关,Logistic多因素[口j归分析显示:器官衰竭数目≥2个、少尿、Cystatin C＞1.3 ms/L结合APACHEⅡ＞15分是急性肾损伤患者的独立死亡危险因素.结论 Cystatin C＞1.3 mg/L结合APACHEⅡ＞15分可以作为评价AKI患者预后的指标.

Analysis on prognostic indicators of acute kidney injury in intensive care uint

Objective To determine the prognostic indicators of acute kidney injury by comprehensive anal-ysis of the mortality risk factors for AKI. Method It' s a retrospective study. The clinical date form March 2008 to August 2009 were collected and analyzed, including gender, age,case history of chronic diseases, the worst values of laboratory examinations within 24 hours of diagnosis (including routine blood tests, blood gas analysis, liver andrenal function, the levels of serum CystatinC , blood electrolytes). According to the 60-day survival of the state will be divided into the survival group and dead groups, Calculation acute physiology and Chronic health evaluation (A-PACHE) Ⅱ scores and mortality.First,univariate analysis was used to screen the variables that related to Prognosis,Calculate odds ratios (OR) and 95% confidence interval (CI) .then Proceeded multiple-factor analysis with Logis-tic regression among to Perform the variables. Results Of the 98 acute kidney injury cases analyzed, 60 cases were males and 38 females, age ranged form 19 to 89 years (mean age 52.4± 16.1 years) .The overall mortality was 34.7%(34/98) within 60d of final diagnosis.The APACHE Ⅱ scores of the non-survivors (17.4 ± 4.3) were higher than that of the survivors(14.2±4.8, P ＜ 0.05). The mortality of the patients with high Cystatin C(＞ 1.3mg/L) was 50% (24/48), which was higher than that of the patients with low Cystatin C (＜ 1.3 mg/L)(20%,10/50; P ＜0.05).Tne results of the univariate analysis indicated that Organ failure≥ 2, Oliguria、 A-PACHEI1 ＞ 15 scores,Cys C ＞ 1.3 mg/L Cys C ＞ 1.3 mg/L Combined APACHEⅡ＞ 15 scores,were the risk factors of AKI. However the logistic reggression suggessted that Organ failure≥2, Oliguria, Cys C ＞ 1.3 mg/L Combined APACHEⅡ＞ 15 scores are the independent risk factors of AKI. Conclusions Cys C ＞ 1.3 mg/L Combined APACHE Ⅱ＞ 15 scores may be used for the prognosis the patients AKI.