老年住院患者急性肾损伤病因及预后相关因素分析

目的研究我科老年人急性肾损伤(acute kidney injury,AKI)的发生率、病因构成及预后。方法通过调查2008年我科住院老年(≥60岁)患者肾功能检测结果,筛检出AKI患者,进行复习病史,总结分析患者的临床特征、肾功能受损的性质、导致AKI的基础疾病等。结果共收集患者123例,AKI的发生率占同期老年肾科住院患者的11.28%。肾前性AKI96例(占78.0%),肾实质性AKI20例(占16.3%),肾后性AKI7例(占5.7%)。AKI3期患者衰竭器官数目最多。单因素分析显示,血清白蛋白水平、血红蛋白、衰竭器官数目、血肌酐上升的百分比、血白细胞计数是影响预后的因素。进一步使用logistic回归分析提示器官衰竭数和血肌酐上升百分比是AKI患者死亡的危险因素。结论老年人AKI病因以肾前性所占比例最大,器官衰竭数目和血肌酐上升的百分比(即上升幅度)是影响老年人AKI预后的因素。早期诊断有助于AKI的治愈,提高存活率。

Clinical analysis of the pathogen and prognosis factor in elderly inpatients with acute kidney injury

Objective To determine the incidence,the constitution of causes and the prognosis of acute kidney injury (AKI)in hospitalized elderly patients.Methods Patients who were admitted in department of geriatric nephrology, medical care center,Beijing Friendship Hospital,Capital Medical University in 2008 were all included in this study.After checking the computer-based data on kidney function,patients with AKI were picked out and further history reviews were demanded to get the information of clinical characteristics,prognosis,severity of kidney injury and the causes of AKI. Results There were 123 cases meeting with the diagnostic criteria of AKI.The overall incidence of AKI was 11.28%.The patterns of AKI included pre-renal(78.0%),renal parenchymal 16.3%) and post-renal AKI(5.7%).The number of organ system failure of stage 3 was higher than other stages.Univariate analysis showed that prognosis was correlated with the level of serum albumin and hemoglobin,number of leukocyte,elevation percentage of serum creatinine and the number of organ system failure.The multivariable logistic regression showed that the number of organ system failure and the elevation percentage of serum creatinine were the risk factors of death among old AKI patients.Conclusions The main cause of AKI in the elderly is infective diseases,especially pulmonary infection.The number of organ system failure and the elevation percentage of serum creatinine are the risk factors of death among old AKI patients.