脓毒症急性肾损伤患者早期肾功能恢复的影响因素分析研究

目的：旨在分析脓毒症诱导的急性肾损伤（SA-AKI）患者肾功能早期恢复的影响因素。方法：回顾性分析2021年1月至2022年12月在复旦大学附属中山医院重症医学科治疗的86例同时符合脓毒症3.0诊断标准和AKI诊断标准的SA-AKI患者。根据其是否在7天内恢复肾功能将其分为恢复组（37例）和未恢复组（49例）。对两组患者的临床资料和实验室检查进行比较，采用单因素和多因素分析筛选变量，确定影响SA-AKI患者肾功能恢复的危险因素，使用ROC曲线评估各因素对SA-AKI早期肾功能恢复的预测价值。结果：SA-AKI的恢复率为43.02%（37/86）。与早期恢复组相比，未恢复组患者肾脏替代治疗率、住院死亡率和28天死亡率均更高（P<0.001）。年龄（P=0.047）、APACHE II评分（P=0.034）、尿量（P=0.025）、尿NGAL（P=0.038）、去甲肾上腺素剂量（P=0.035）是影响SA-AKI患者肾功能恢复的独立危险因素，用以上5个指标拟合出最终模型logit(P)=-4.091+0.001*尿NGAL-0.001*尿量+0.040*年龄+0.073*APACHEII评分+1.906*去甲肾上腺素剂量。该模型预测SA-AKI恢复的AUC为0.823，敏感度为73.5%，特异度为81.1%。结论：SA-AKI患者早期肾功能未恢复与预后不良相关。年龄、APACHE II评分、尿量、尿NGAL、去甲肾上腺素剂量为影响SA-AKI患者肾功能早期恢复的独立危险因素，联合指标的综合判断对SA-AKI患者早期肾损伤恢复具有预测价值。

A study on the predictive role of urine output and urine NGAL on early renal function recovery in SA-AKI patients

Objective This study aims to analyze the factors influencing the early recovery of renal function in patients with sepsis-induced acute kidney injury (SA-AKI)Methods A retrospective analysis was conducted on 86 patients treated in the Intensive Care Unit at Zhongshan Hospital affiliated with Fudan University from January 2021 to December 2022, who met both the Sepsis 3.0 diagnostic criteria and the AKI diagnostic standards for sepsis-induced acute kidney injury (SA-AKI). Patients were divided into a recovery group (37 cases) and a non-recovery group (49 cases) based on whether their renal function recovered within 7 days. Clinical data and laboratory tests of both groups were compared. Univariate and multivariate analyses were used to identify risk factors affecting renal function recovery in SA-AKI patients, and ROC curves were utilized to evaluate the predictive value of these factors for early renal function recovery in SA-AKI. Results The recovery rate of SA-AKI was 43.02% (37/86). Compared with the early recovery group, the renal replacement therapy rate, in-hospital mortality and 28-day mortality of patients in the non-recovery group were higher (P<0.001). Age (P=0.047), APACHE II score (P=0.034), urine output (P=0.025), urinary NGAL (P=0.038), and norepinephrine dose (P=0.035) were identified as independent risk factors affecting renal function recovery in SA-AKI patients. The final model logit(P) = -4.091+0.001 * urine NGAL-0.001 * urine volume + 0.040 * age + 0.073 * APACHEII score + 1.906 * norepinephrine dose was fitted using the above indicators. The model predicted early SA-AKI recovery with an AUC of 0.823, a sensitivity of 73.5%, and a specificity of 81.1%. Conclusion Lack of early renal function recovery in SA-AKI patients is associated with poor prognosis. Age, APACHE II score, urine output, urine NGAL, and the dose of norepinephrine are independent risk factors affecting early renal function recovery in SA-AKI patients. The combined assessment of these indicators has predictive value for the early recovery from renal injury in SA-AKI patients.