脓毒症继发急性肾损伤过程中的凝血变化

目的 脓毒症继发急性损伤是脓毒症患者死亡的重要原因之一，凝血变化是急性肾损伤重要因素。本研究旨在筛选脓毒症过程中同急性肾损伤相关的凝血指标。方法 本研究收集外科、急诊及呼吸重症监护室的脓毒症患者，纳入132例脓毒症患者，其中合并急性肾损伤64例，非急性肾损伤68例。收集各组患者一般资料及入ICU第1个24h内各项实验室指标，利用Logistic回归分析及Cox回归分析进行统计学分析。结果 AKI组与非AKI组相比，抗凝血酶Ⅲ(P=0.007)显著降低，D-二聚体则显著升高(P=0.006)。二分类变量Logistic回归显示，D-二聚体与抗凝血酶Ⅲ为脓毒症继发AKI的危险因素，OR值分别为3.018(95%CI:1.127～8.083)和2.89(95%CI:1.181～7.070),P<0.05。利用Cox回归分析显示仅有D-二聚体同病死率相关，HR值1.347(95%CI:1.081～1.677),P=0.008。结论 D-二聚体和抗凝血酶Ⅲ是脓毒症继发AKI发生的独立危险因素。D-二聚体升高同脓毒症继发AKI的28d病死率高相关。

The Coagulation of Acute Kidney Inj ury of Sepsis Patients

Objective Acute kidney injury is one of the major causes of death in patients with sepsis. Coagulation in patients with acute kidney injury is a key factor of injury. Our study aimed to screen indicators of coagulation which were related to acute kidney injury of sepsis patients.Methods The study cohort was collected from the Surgery, Emergency and Respiratory Intensive Care Units, which were divided into the acute kidney injury(AKI) group and non-AKI group. The general clinical data and laboratory indicators within the first 24 hours of those patients were collected. Logistic regression and Cox regression models were used for the statistical analysis.Results A total of 132 patients with sepsis were enrolled in this study, including 64 patients with AKI and 68 patients without AKI. Compared with the non-AKI group, antithrombin Ⅲ(P=0.007) was significantly reduced in the AKI group, while D-dimer was significantly increased(P=0.006). Logistic regression analysis showed that D-dimer and antithrombin Ⅲ were independent risk factors for sepsis patients with AKI, with OR of 3.018(95%CI:1.127-8.083) and 2.89(95%CI:1.181-7.070), P<0.05,respectively. Cox regression analysis showed that D-dimer was associated with the 28-day mortality with HR of 1.347(95% CI:1.081-1.677),(P=0.008).Conclusion D-dimer and antithrombin Ⅲ are independent risk factors for sepsis patients with AKI. Elevated D-dimer is related to 28-day mortality rate of sepsis patients of AKI.