住院老年人短暂性与持续性急性肾损伤发生情况及临床特点分析

目的对老年急性肾损伤(AKI)患者进行随访观察，分析短暂性AKI与持续性AKI的发生率、临床特点及相关危险因素。 方法选择2007年1月至2015年12月就诊于解放军总医院老年病房≥75岁的住院患者为研究对象。根据发生AKI后3 d时肾功能恢复情况将患者病历资料分为短暂性AKI与持续性AKI进行分析。多因素Logistic回归分析老年人发生持续性AKI的相关危险因素。 结果研究期间，共有652例住院患者发生AKI，其中男性623例，占95.6%，中位年龄87(84～91)岁。652例AKI患者，短暂性AKI 270 (41.4%)例，持续性AKI 382(58.6%)例。多因素Logistic回归分析显示Scr峰值(OR＝1.020; 95%CI: 1.015～1.026; P<0.001)、血尿素氮(BUN)增高(OR＝1.028; 95%CI: 1.000～1.056; P＝0.047)、高尿酸(OR ＝1.002; 95%CI: 1.000～1.003; P＝0.040)、伴有机械通气(OR＝1.610; 95%CI: 1.012～2.562; P＝0.044)是影响高龄老年患者发生持续性AKI的独立危险因素；平均动脉压(OR＝0.985; 95%CI: 0.971～1.000; P＝0.043)升高和血红蛋白升高(OR＝0.989; 95% CI: 0.980～0.999; P＝0.025)是影响高龄老年患者发生持续性AKI的独立保护因素。 结论住院高龄老年患者短暂性AKI的发生率高达近42%。提高临床医师的重视程度，增加对Scr的监测频率，是降低AKI漏诊率的有效手段。早期识别危险因素，可改善AKI患者的短期预后。

Analysis of occurrence and clinical characteristics of transient and persistent acute kidney injury in hospitalized elderly patients

ObjectiveWe aimed to study the incidence, clinical characteristics, and risk factors of transient and persistent acute kidney injury (AKI) in very elderly patients. MethodsWe retrospectively enrolled very elderly patients (aged ≥75 years) from the Geriatric Department of the Chinese PLA General Hospital between January 2007 and December 2015. AKI patients were divided into transient or persistent AKI groups based on their renal function at 3 days post-AKI. Multivariate logistic regression analysis was made for the risk factors associated with persistent AKI in the elderly. ResultsDuring the study period, a total of 652 inpatients developed AKI, including 623 males, accounting for 95.6%, with a median age of 87 (84-91) years. Of the 652 patients with AKI, transient AKI occurred in 270 cases (41.4%) and persistent AKI in 382 cases (58.6%). Multivariate logistic regression analysis showed that the Scr peak value (OR=1.020; 95%CI: 1.015-1.026; P<0.001), the increase of blood urea nitrogen (BUN) (OR=1.028; 95%CI: 1.000-1.056; P=0.047), the increase of uric acid (OR=1.002; 95%CI: 1.000-1.003; P=0.040), and the requirement of mechanical ventilation (OR=1.610; 95%CI: 1.012-2.562; P=0.044) were independent risk factors of the persistent AKI in the elderly patients, while the increase of mean arterial pressure (OR=0.985; 95%CI: 0.971-1.000; P=0.043) and elevation of hemoglobin (OR=0.989; 95%CI: 0.980- 0.999; P=0.025) were independent protective factors for persistent AKI in the elderly patients. ConclusionsThe incidence of transient AKI in the elderly patients was as high as 42%. Increasing the attention of clinicians, and increasing the frequency of monitoring Scr were effective methods to reduce the rate of missed diagnosis for AKI. Early identification of the risk factors might improve the short-term outcomes of patients with AKI.