住院死亡患者发生医院获得性急性肾损伤的影响因素

目的　探讨住院期间死亡患者发生医院获得性急性肾损伤（AKI）的影响因素。方法　选取2016年1月—2018年1月在首都医科大学附属北京友谊医院内科系统住院期间发生死亡、年龄≥85岁的老年患者（≥85岁组，n=193）、年龄18~64岁的患者（18~64岁组，n=91）为研究对象。根据患者病历和住院记录，收集患者一般情况、合并症、实验室指标等；采用Logistic 回归分析探讨年龄≥85岁和18~64岁住院期间死亡患者发生AKI的影响因素。结果　≥85岁组患者AKI发生率为58.5%（113/193），18~64岁组患者AKI发生率为54.9%（50/91）。≥85岁组AKI和非AKI患者合并冠心病、慢性肾脏病（CKD）、贫血、心力衰竭、脓毒血症的患者比例以及血红蛋白水平、血肌酐（Scr）、血尿素氮（BUN）、估算肾小球滤过率（eGFR）比较，差异有统计学意义（P<0.05）。18~64岁组AKI和非AKI患者合并高脂血症、贫血、心力衰竭的患者比例以及血红蛋白水平、血清清蛋白水平比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析显示，是否合并心力衰竭、脓毒血症及基础BUN水平是≥85岁组住院期间死亡患者发生AKI的影响因素（P<0.05）；是否合并贫血和心力衰竭是18~64岁组住院期间死亡患者发生AKI的影响因素（P<0.05）。结论　合并心力衰竭、脓毒血症及基础BUN水平高是≥85岁组住院期间死亡患者发生AKI的独立危险因素；而合并贫血和心力衰竭是18~64岁组住院期间死亡患者发生AKI的独立危险因素。早期评估并积极干预危险因素有助于改善患者的预后，降低死亡风险。

Risk Factors for Hospital-acquired Acute Kidney Injury in Patients Died During Hospitalization

Objective　To investigate the risk factors of hospital-acquired acute kidney injury（AKI） in patients who died during hospitalization.Methods　The participants were recruited from Internal Medicine Department，Beijing Friendship Hospital ，Capital Medical University，from January 2016 to January 2018.All of them died during hospitalization，including 193 aged ≥85（aged ≥85 group） and 91 aged 18-64（aged 18-64 group）.By reviewing the medical records and hospitalization records，their general clinical data，prevalence of comorbidity，laboratory findings and so on were collected.Logistic regression analysis was used to study the risk factors of hospital-acquired AKI in both groups.Results　The prevalence of AKI was 58.5%（113/193） in the aged ≥85 group，and 54.9%（50/91） in the aged 18-64 group.In the aged ≥85 group，significant differences were found in the prevalence of coronary heart disease（CHD），chronic kidney disease（CKD），anemia，heart failure and sepsis，and mean levels of hemoglobin，serum creatinine（Scr），blood urea nitrogen（BUN） and estimated glomerular filtration rate（eGFR） between individuals with AKI and those without（P<0.05）.In the aged 18-64 group，the prevalence of hyperlipidemia，anemia and heart failure，and mean levels of hemoglobin and serum albumin differed significantly between individuals with AKI and those without（P<0.05）.Multivariate logistic regression analysis showed that the prevalence of heart failure，sepsis and increased baseline BUN were risk factors of AKI in the aged ≥85 group（P<0.05）；the prevalence of anemia and heart failure were risk factors of AKI in the aged 18-64 group（P<0.05）.Conclusion　The prevalence of comorbidities of heart failure，sepsis and increased baseline BUN are independent risk factors of AKI in aged ≥85 patients who died during hospitalization，and the prevalence of comorbidities of anemia and heart failure are independent risk factors of AKI in aged 18-64 patients who died during hospitalization.Early assessment and active intervention of risk factors may improve the prognosis and reduce the risk of death.