危重症患者脓毒症急性肾损伤后的早期恢复模式与预后  

Early recovery status and outcomes after sepsis-associated acute kidney injury in critically ill patients

作　　者：罗晓琴 晏萍 张宁雅 王梅 邓颖豪 伍婷 吴皙 刘茜 王鸿燊 王琳 康怡昕 段绍斌[1] LUO Xiaoqin;YAN Ping;ZHANG Ningya;WANG Mei;DENG Yinghao;WU Ting;WU Xi;LIU Qian;WANG Hongshen;WANG Lin;KANG Yixin;DUAN Shaobin(Department of Nephrology,Second Xiangya Hospital,Central South University,Changsha 410011;Information Center,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院肾内科,长沙410011 [2]中南大学湘雅二医院信息中心,长沙410011

出　　处：《中南大学学报（医学版）》2022年第5期535-545,共11页Journal of Central South University ：Medical Science

基　　金：This work was supported by the National Natural Science Foundation of China(81873607).

摘　　要：目的:急性肾损伤(acute kidney injury,AKI)是脓毒症的危重症患者常见的并发症之一,可增加患者死亡、心血管事件和慢性肾功能不全的发生风险。AKI持续时间和AKI后肾功能恢复状况可影响患者的预后,但是脓毒症AKI后患者的早期恢复情况是否与预后密切相关,目前仍存在争议。早期预测AKI后肾功能恢复状态有利于制订个体化的治疗策略和预防严重并发症的发生,然而如何在临床上早期识别脓毒症AKI患者中肾功能未恢复的高危患者尚不清楚。本研究旨在探讨危重症患者脓毒症AKI后早期恢复状态与预后的关系,并早期识别肾功能未恢复的危险因素,以提高患者的生存质量。方法:回顾性分析2015年1月至2017年3月在中南大学湘雅二医院和湘雅三医院重症监护室(intensive care unit,ICU)住院且在进入ICU后48 h内发生AKI的脓毒症患者的临床资料。脓毒症的诊断根据第3版脓毒症与感染性休克定义国际共识(the Third International Consensus Definitions for Sepsis and Septic Shock,Sepsis-3),AKI的诊断和分期根据2012年改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,KDIGO)指南。根据诊断AKI后第7天的恢复状态,将脓毒症AKI患者分为完全恢复、部分恢复和未恢复3组。收集患者的基线特征,包括人口学特征、合并症、进入ICU时的临床和实验室检查资料以及进入ICU后24 h内的干预情况。研究的主要结局为90 d时死亡和慢性透析的复合结局,次要结局包括ICU停留天数、住院天数和持续性肾功能不全。使用多因素回归分析评估AKI后早期恢复状态对90 d预后的预测价值,并确定AKI后肾功能未恢复的危险因素。此外,我们进一步分别对诊断AKI后第7天仍在院的患者、无慢性肾脏病病史的患者和AKI分期为2~3期的患者进行敏感性分析。结果:在553例脓毒症AKI患者中,完全恢复组为251例(45.4%),部分恢复组为73例(13.2%),未�Objective:Acute kidney injury(AKI)is one of the common complications in critically ill septic patients,which is associated with increased risks of death,cardiovascular events,and chronic renal dysfunction.The duration of AKI and the renal function recovery status after AKI onset can affect the patient prognosis.Nevertheless,it remains controversial whether early recovery status after AKI is closely related to the prognosis in patients with sepsis associated AKI(SA-AKI).In addition,early prediction of renal function recovery after AKI is beneficial to individualized treatment decision-making and prevention of severe complications,thus improving the prognosis.At present,there is limited clinical information on how to identify SA-AKI patients at high risk of unrecovered renal function at an early stage.The study aims to investigate the association between early recovery status after SA-AKI,identify risk factors for unrecovered renal function,and to improve patients’quality of life.Methods:We retrospectively analyzed clinical data of septic patients who were admitted to the intensive care unit(ICU)and developed AKI within the first 48 hours after ICU admission in the Second Xiangya Hospital and the Third Xiangya Hospital of Central South University from January 2015 to March 2017.Sepsis was defined based on the Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3).AKI was diagnosed and staged according to the 2012 Kidney Disease:Improving Global Outcomes(KDIGO)guideline.SA-AKI patients were assigned into 3 groups including a complete recovery group,a partial recovery group,and an unrecovered group based on recovery status at Day 7 after the diagnosis of AKI.Patients’baseline characteristics were collected,including demographics,comorbidities,clinical and laboratory examination information at ICU admission,and treatment within the first 24 hours.The primary outcome of the study was the composite of death and chronic dialysis at 90 days,and secondary outcomes included length of stay in the

关 键 词：脓毒症 急性肾损伤 恢复 预后 重症监护室 

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