102例急性肾损伤患者进行肾脏替代治疗的预后分析

目的探讨急性肾损伤(acute kidney injury,AKI)患者进行肾脏替代治疗的时机及其对预后的可能影响。方法回顾性分析507例AKI患者,选取其中接受肾脏替代治疗(renal replacement therapy,RRT)的102例患者资料,分析RRT起始时的临床资料和预后的关系,应用相关性分析和Logistic多因素分析等统计方法,筛选决定RRT合适时机的重要指标。结果从血清肌酐、尿素氮、尿量、TCO2、血钾和AKI持续时间等指标中,筛选出与预后相关的TCO2和尿量,进一步的分析推论出多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)也是影响预后的因素。应用Logistic多因素分析建立接受RRT的AKI患者的预后预测模型,其敏感度78.8%,特异度78.0%,预测准确性达87.3%。ROC曲线下面积为0.809。Hosmer-Lemeshow拟合优度检验P=0.295。结论①在同样的疾病和临床并发症背景下,在尿量<600ml/d和TCO2<22.2mmol/L之前进行RRT有利于肾脏恢复;②MODS作为独立危险因素影响AKI的预后,在MODS发生前开始RRT是改善AKI预后的关键。

The prognositic analysis of 102 cases of acute kidney injury patients with renal replacement therapy

Ojective Analyze AKI patients who undertook renal replacement therapy （RRT） to screen the important indicators to decide the appropriate timing of RRT and its influence on prognosis. Method The clinical data of 507 AKI patients were reviewed. 102 AKI patients who undertook RRT with complete medical records were further analyzed to reveal the relationship between clinical data and prognosis. Statistical methods were used to screen the important indicators of the appropriate timing of RRT. Results TCO2 and urine volume were screened as predict factors of prognosis after the comparsion of the relationship of data at the onset of RRT and the prognosis. Further analysis revealed that MODS was also a powerful factor. The prediction model for AKI patients who undertook RRT was established after multiple variable Logistic regression analysis. The sensitivity and specifity of the model was respectively 78.8% and 78.0%, and the area under ROC was 0.809. The Hosmer-Lemeshow goodness-of-fit tests of the model was P=0.295. Conclusion Under the senario of the same disease and clinical back- ground, the recovery of kidney function may benefit from initiating RRT before urine output〈600ml/d and/or TCO2〈22.2mmol/L. As an independent risk factor, MODS indicates a worse prognosis; the determinant of im- proving clinical outcome of AKI is initiating RRT before MODS occurs.