维持性血液透析患者发生感染相关住院的临床特征和危险因素分析

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者发生感染相关住院的临床特征及危险因素。方法回顾性选取2013年12月1日至2018年2月28日在南昌大学第一附属医院长期规律性血液透析的患者,并进行至少1年的病例随访,随访截至2019年2月28日。收集患者人口学及临床资料等基线资料,按照是否发生感染相关住院分为感染组与非感染组,比较两组患者发生感染的临床特征以及相关因素。采用Logistic回归分析法分析MHD患者发生感染相关住院的影响因素。结果共纳入392例患者,男性255例(65.1%),年龄(59.39±15.28)岁,其中感染组111例,非感染组281例。以糖尿病肾病为原发病的患者感染率最高,达32.2%。感染发生的主要部位为肺部,占78.4%,远高于处于第2位的导管相关性感染,发生感染后喹诺酮类及头孢类抗生素常作为首选药物。与非感染组相比,感染组年龄更大[(62.96±15.16)岁比(57.98±15.12)岁,t=-2.607,P=0.004],合并糖尿病(45.9%比32.4%,χ2=6.334,P=0.012)和既往有吸烟史(30.6%比18.5%,χ2=6.831,P=0.009)所占比例更高,首次透析住院时间[13.0(9.0,18.0)d比12.0(9.0,17.5)d,Z=3.659,P=0.001]更长,血红蛋白[(74.43±19.93)g/L比(79.06±17.10)g/L,t=1.612,P=0.022]、白蛋白[(32.63±5.33)g/L比(33.99±6.14)g/L,t=2.062,P=0.029]以及红细胞计数[2.53×1012/L(2.06×1012/L,3.06×1012/L)比2.68×1012/L(2.28×1012/L,3.07×1012/L),Z=2.118,P=0.034]更低。多因素Logistic回归分析结果显示,年龄增加(每增加1岁,OR=1.016,95%CI 1.003~1.030,P=0.017)和首次透析时住院时间延长(每增加1 d,OR=1.047,95%CI 1.014~1.080,P=0.008)是MHD患者发生感染相关住院的独立危险因素,血红蛋白升高(每增加1 g/L,OR=0.987,95%CI 0.975~0.999,P=0.033)是患者发生感染相关住院的保护因素。结论原发病为糖尿病肾病的MHD患者感染发生率最高,肺部感染的发生率远高于导管相关性感染、尿路感染、败血症等其他类型的感染。年龄增加和低血红蛋白是MHD患者容易发生感染的危险因素。

Clinical characteristics and risk factors of infection-related hospitalization in maintenance hemodialysis patients

Objective To explore the clinical characteristics and risk factors of maintenance hemodialysis (MHD) patients combined with infection-related hospitalization. Methods Patients with MHD from December 1, 2013 to February 28, 2018 were retrospectively selected and then followed up for at least 1 year until February 28, 2019. Baseline data including demographic and clinical data of patients were collected. According to whether the infection-related hospitalization occurred, patients were divided into infection group and non-infection group. The clinical characteristics and related factors were compared between the two groups. Logistic regression model was used to analyze the influencing factors. Results A total of 392 patients were included in the study. Two hundred and fifty-five cases were males, accounting for 65.1%. The age was (59.39±15.28) years old. The infection rate of diabetic kidney disease patients was the highest (32.2%). The main site of infection was the lung, accounting for 78.4%, which was far higher than the catheter-related infection in the second position. After infection, quinolones and cephalosporins were often the preferred drugs. Compared with the non-infection group, the infection group had older age [(62.96±15.16) years vs (57.98±15.12) years, t=-2.607, P=0.004], higher proportion of comorbid diabetes (45.9% vs 32.4%, χ2=6.334, P=0.012) and previous smoking history (30.6% vs 18.5%, χ2=6.831, P=0.009), longer time of first dialysis stay [13.0(9.0, 18.0) d vs 12.0(9.0, 17.5) d, Z=3.659, P=0.001] and lower hemoglobin [(74.43±19.93) g/L vs (79.06±17.10) g/L, t=1.612, P=0.022] , albumin [(32.63±5.33) g/L vs (33.99±6.14) g/L, t=2.062, P=0.029] and red blood cell count [2.53×1012/L (2.06×1012/L, 3.06×1012/L) vs 2.68×1012/L(2.28×1012/L, 3.07×1012/L), Z=2.118, P=0.034]. Multivariate logistic analysis found that older age (every 1 year, OR=1.016, 95%CI 1.003-1.030, P=0.017) and longer hospital stay at first dialysis (every 1 d, OR=1.047, 95%CI 1.014-1.080, P=0.008) were independent risk factors, and higher hemoglobin (every 1 g/L, OR=0.987, 95%CI 0.975-0.999, P=0.033) was a protective factor for infection-related hospitalization in MHD patients. Conclusions MHD patients with diabetic kidney disease have the highest infection incidence. The incidence of pulmonary infection is much higher than other types of infection such as catheter-related infection, urinary tract infection and sepsis. Aging and low hemoglobin are risk factors for MHD patients to prone to co-infection.