重症急性肾功能衰竭预后影响因素分析

目的了解影响重症急性肾功能衰竭患者预后的主要危险因素。方法总结2008年1月至2009年12月解放军总医院收治的进行肾脏替代治疗的100例重症急性肾功能衰竭患者的临床数据,采用APACHEⅡ评分评估患者病情严重程度,SOFA评分评估患者重要器官功能,采用单因素分析和多因素Lo-gistic回归方法分析影响患者肾功能恢复的因素,应用Kap lan-M e ier生存分析和COX比例风险模型分析患者累积存活率和影响患者生存的主要因素。结果伴有呼吸衰竭的患者存活率低于无呼吸衰竭患者(P=0.016);肝脏SOFA积分≥2的患者存活率低于肝脏SOFA积分<2患者(P=0.011);APACHEⅡ评分>25的患者存活率明显低于APACHⅡ评分≤25患者(P=0.001)。APACHEⅡ评分是影响患者病死率的因素(P<0.01,95%C I:1.048~1.076)。结论 APACHⅡ评分高低是影响重症急性肾功能衰竭患者肾功能恢复和最终死亡的主要因素,避免呼吸衰竭、脓毒症的发生及肝功能的恶化,有利于降低患者病死率。

Analysis of risk factors determining prognosis of 100 critically ill patients with severe acute renal failure

Objective To learn risk factors associated with prognosis of critically ill patients with severe acute renal failure(sARF).Methods Clinical records of 100 patients with acute renal failure performed renal replacement therapy(RRT) were collected and patients were prospectively followed up for 3~320 days.Severity of illness was assessed using the Acute Physiology and Chronic Health Evaluation(APACHE) Ⅱ score and Sepsis-related Organ Failure Assessment(SOFA) score.Univariate analysis and multivariable Logistic regression model were developed to assess factors associated with recovery of renal function.Kaplan-Meier survival analysis and Cox proportional hazard model were developed to assess factors affecting survival rate of patients.Results Lower APACHE Ⅱ score and SOFA score of liver≥2 were independently associated with renal recovery in the multivariate analysis(P<0.05).Survival rate of patients with sepsis was lower than patients without sepsis(P=0.036),survival rate of patients with respiratory failure was lower than patients without respiratory failure(P=0.016),survival rate of patients with SOFA score of liver≥2 was lower than patients with SOFA score of liver<2(P=0.011),and survival rate of patients with APACHE Ⅱ score>25 was lower than patients with APACHE Ⅱ score>25(P=0.001).APACHE Ⅱ score was risk factor associated with a higher mortality in Cox proportional hazard modelP=0.000,Exp(B)=1.106,95% confidence interval 1.048~1.076].Conclusion Mortality rate of critically ill patients with severe acute renal failure is high.APACHE Ⅱ score is risk factor associated with prognosis of sARF.Treatment of respiratory failure,sepsis and protection of liver function are important measures for renal recovery and survival of sARF.