脓毒症相关性急性肾损伤发生时间与临床结局的关系  

Association between onset time of sepsis-associated acute kidney injury and clinical outcome in patients with sepsis

作　　者：王楠 王美平 姜利 娄然 苏维雪 朱波[2] 席修明[2] Wang Nan;Wang Meiping;Jiang Li;Lou Ran;Su Weixue;Zhu Bo;Xi Xiuming(Department of Critical Care Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Critical Care Medicine,Fuxing Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学宣武医院重症医学科,北京100053 [2]首都医科大学附属复兴医院重症医学科,北京100038

出　　处：《中华医学杂志》2024年第21期1972-1978,共7页National Medical Journal of China

基　　金：北京市重大疫情防治重点专科建设项目(2021-451);北京市重大疫情防治重点专科项目(2021-135);北京市自然科学基金(7334335)

摘　　要：目的探讨脓毒症相关急性肾损伤(SA-AKI)发生时间与不良临床结局的关系。方法数据来源于2012年3至8月于北京市28家三级甲等医院的30个重症监护病房(ICU)发起的北京市急性肾损伤调查(BAKIT)研究。选取入住ICU时间超过24 h,且在ICU期间同时诊断脓毒症和急性肾损伤者653例,其中男414例,女239例,年龄(68.2±17.0)岁。根据SA-AKI发生时间将患者分为早发AKI(E-AKI)组(入ICU后48 h内发生AKI)和晚发AKI(L-AKI)组(入ICU 48 h后发生AKI),主要结局为主要肾脏不良事件(MAKE),包括30 d内全因死亡、依赖肾脏替代治疗或血肌酐未恢复到基础值的1.5倍以内。采用多因素logistic回归模型分析SA-AKI的发生时间与临床结局的关系。结果653例SA-AKI患者中E-AKI组423(64.8%)例,L-AKI组230(35.2%)例,405(62.0%)例患者在住院期间发生MAKE,301(46.1%)例患者住院期间死亡。与E-AKI组患者相比,L-AKI组患者AKI 3级比例[55.7%(128/230)比40.2%(170/423),P<0.001]、MAKE发生率[72.6%(167/230)比56.3%(238/423),P<0.001]及住院病死率[55.2%(127/230)比44.1%(174/423),P=0.001]更高,且L-AKI组MAKE的发生风险增加2.55倍(OR=3.55,95%CI:1.94~6.04),住院死亡风险增加1.84倍(OR=2.84,95%CI:1.44~5.60)(均P<0.05)。结论与E-AKI患者相比,发生L-AKI的脓毒症患者临床结局更差。Objective To explore the relationship between the onset time of sepsis-associated acute kidney injury(SA-AKI)and adverse clinical outcomes.Methods Data were derived from Beijing Acute Kidney Injure Trial(BAKIT)which investigated the epidemiology of acute kidney injury(AKI)in critically ill patients at 30 intensive care units(ICU)of 28 tertiary hospitals in Beijing from 1 March to 31 August 2012.Patients who were older than 18 years and diagnosed with sepsis and AKI,and expected to stay in ICU for at least 24 h were included in this study.A total of 653 patients were included in this study,414 males and 239 females with a mean age of(68.2±17.0)years.According to the onset time of SA-AKI,patients were grouped into early AKI(E-AKI)(AKI occurred within 48 hours after ICU admission)and late AKI(L-AKI)(AKI occurred after 48 hours of ICU admission)group.The primary outcome was major adverse kidney events(MAKE),consisted of all-cause mortality,renal replacement therapy-dependence,and an inability to recover to 1.5 times of the baseline creatinine value up to 30 days.Multivariable logistic regression was used to investigate the association between the onset time of SA-AKI and clinical outcomes.Results A total of 653 patients with SA-AKI were included,423(64.8%)patients developed E-AKI,230(35.2%)cases developed L-AKI,MAKE occurred in 405(62.0%)cases,and 301(46.1%)patients died in hospital.Compared with E-AKI group,L-AKI patients showed higher AKI 3 level rate[55.7%(128/230)vs 40.2%(170/423),P<0.001],incidence of MAKE[72.6%(167/230)vs 56.3%(238/423,P<0.001)]and hospital mortality[55.2%(127/230)vs 44.1%(174/423),P=0.001].The risk of MAKE and in-hospital mortality in L-AKI group increased for 2.55-fold times(OR=3.55,95%CI:1.94-6.04)and 1.84-fold times(OR=2.84,95%CI:1.44-5.60)when compared with those in E-AKI,respectively(both P<0.05).Conclusion Late timing onset of SA-AKI is associated with poor clinical outcomes.

关 键 词：脓毒症 脓毒症相关急性肾损伤 主要肾脏不良事件 住院病死率 

分 类 号：R459.7[医药卫生—急诊医学] R692.5[医药卫生—治疗学]