凝血指标与脓毒症相关急性肾损伤患者全因死亡的相关性分析  

Association between coagulation indicators and all-cause mortality in sepsis-related acute kidney injury patients

作　　者：莫曼秋 潘玲[1] 严官强 蒋玲[1,2] 杨桢华[1] 伍巧源[1] 廖蕴华[1] Mo Manqiu;Pan Ling;Yan Guanqiang;Jiang Ling;Yang Zhenhua;Wu Qiaoyuan;Liao Yunhua(Department of Nephrology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;First Clinical Medical College,Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院肾内科,南宁530021 [2]广西医科大学第一临床医学院,南宁530021

出　　处：《中华肾脏病杂志》2019年第10期758-764,共7页Chinese Journal of Nephrology

摘　　要：目的了解脓毒症相关急性肾损伤(AKI)患者的全因死亡率,探讨凝血指标与脓毒症相关AKI全因死亡的相关关系。方法回顾性分析2016年6月10日至2018年6月10日在广西医科大学第一附属医院住院诊治的脓毒症相关AKI患者的临床资料,根据28d的转归情况分为死亡组和存活组。比较两组间基线凝血指标水平及一般临床资料的差异,采用Cox回归模型分析影响脓毒症相关AKI全因死亡的危险因素,通过受试者工作特征曲线(ROC)评估独立危险因素对患者死亡的预测价值,采用Kaplan-Meier方法绘制生存曲线。结果共纳入214例脓毒症相关AKI患者,男女比为2.57∶1,年龄(57.90±16.96)岁。74.77%(160/214)的患者在诊断时至少合并一项凝血指标异常,37.38%(80/214)的患者合并多器官功能障碍综合征(MODS),44.86%(96/214)的患者接受过肾脏替代治疗(RRT)。28d全因死亡率为28.04%(60/214)。死亡组(n=60)与存活组(n=154)间年龄及性别差异无统计学意义(P>0.05)。死亡组基线凝血酶原时间、活化部分凝血酶时间(APTT)、国际标准化比率、凝血酶时间、降钙素原及肺部感染、凝血指标异常、MODS发生率均高于存活组(均P<0.05),而体重、血红蛋白、中性粒细胞百分比、血小板计数、凝血酶原活动度、血清白蛋白、RRT比例低于存活组(均P<0.05)。Cox回归分析提示,基线APTT延长是脓毒症相关AKI患者全因死亡的独立危险因素(HR=2.610,95%CI1.077~6.326,P=0.034)。Kaplan-Meier生存曲线提示,APTT延长组28d累积生存率低于非APTT延长组(37.1%比70.6%,Log-rankχ^2=16.881,P<0.001),平均生存时间短于非APTT延长组(21.79d比24.73d)。结论脓毒症相关AKI患者普遍存在凝血异常。凝血指标与患者全因死亡密切相关,APTT延长是脓毒症相关AKI患者全因死亡的独立危险因素。Objective To explore the association between coagulation indicators and all-cause mortality in sepsis-related acute kidney injury (AKI) patients. Methods Clinical data of patients with sepsis-related AKI admitted to the First Affiliated Hospital of Guangxi Medical University from June 10, 2016 to June 10, 2018 were retrospectively analyzed. The patients were divided into death group and survival group according to the outcome of 28 d. The risk factors of all-cause mortality in sepsis-related AKI patients were analyzed. Receiver operating characteristic curve (ROC) was used to evaluate the prognostic value of independent risk factor for the death of sepsis-related AKI patients and Kaplan-Meier method was used to draw the survival curve. Results A total of 214 patients with sepsis-related AKI were enrolled into this study. Their age was (57.90±16.96) years old, and the ratio of male to female was 2.57∶1. There was at least one abnormal coagulation indicator in 74.77%(160/214) of patients, and multiple organ dysfunction syndrome (MODS) in 37.38% of patients. The 28-day all-cause mortality was 28.04%(60/214). Prothrombin time, activated partial thrombin time (APTT), international standardized ratio, thrombin time, procalcitonin, abnormal coagulation indicators and the incidence of MODS in the death group were higher than those in the survival group, while body weight, hemoglobin, the percent of neutrophile granulocyte, platelet count, prothrombin activity, serum albumin and the proportion of renal replacement therapy (RRT) were lower than those in the survival group (all P<0.05). Cox regression analysis suggested that sepsis-related AKI patients with prolonged APTT had a higher risk for all-cause death (HR=2.610, 95%CI 1.077-6.326, P=0.034). The Kaplan-Meier survival curve indicated that 28 d survival rate of APTT extension group was lower than that of the non-APTT extension group (37.1% vs 70.6%, Log-rank χ^2=16.881, P<0.001), and the average survival time was shorter than that of the non-APTT extension group (2

关 键 词：脓毒症 急性肾损伤 死亡率 危险因素 凝血指标 

分 类 号：R692[医药卫生—泌尿科学] R45[医药卫生—外科学]