重型新型冠状病毒肺炎患者发生急性肾损伤的危险因素及其预测价值  

Risk factors of acute kidney injury in severe COVID-19 patients and their predictive values

作　　者：牛丹[1] 张怡[1] 董道然[1] Niu Dan;Zhang Yi;Dong Dao-ran(Intensive Care Unit,Shaanxi Provincial People’s Hospital,Xi’an 710068,China)

机构地区：[1]陕西省人民医院重症医学科,西安710068

出　　处：《临床肾脏病杂志》2024年第9期720-727,共8页Journal Of Clinical Nephrology

基　　金：陕西省重点研发计划(2021SF-257)。

摘　　要：目的筛选重型新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者发生急性肾损伤(acute kidney injury,AKI)的危险因素,构建预测模型,并探讨其预测价值。方法回顾性分析2022年12月1日至2023年7月1日在陕西省人民医院重症医学科确诊为重型COVID-19的150例患者的临床资料,根据是否发生AKI分为AKI组(54例)和非AKI组(96例),比较两组患者的临床资料,采用多因素Logistic回归分析筛选重型COVID-19患者发生AKI的危险因素,构建预测模型,并采用受试者工作特征(receiver operating chatacteristic,ROC)曲线分析该模型的预测价值。结果AKI组患者的年龄为74.50(63.00,81.50)岁,明显低于非AKI组75.00(70.00,83.00)岁;AKI组合并慢性阻塞性肺疾病比例(1.85%)和接受经鼻高流量氧疗治疗比例(38.89%),均明显低于非AKI组(13.54%和58.33%)(均P<0.05)。AKI组急性生理与慢性健康评分Ⅱ[20.50(15.00,25.00)]和序贯器官衰竭评分(sequential organ failure assessment,SOFA)[8.00(6.00,10.00)]均明显高于非AKI组[16.00(13.00,18.25)和5.00(4.00,6.00)];AKI组患者合并细菌感染比例(61.11%)和接受有创通气治疗比例(57.41%)均显著高于非AKI组(40.62%和25.00%)(均P<0.05)。AKI组患者氧合指数[109.55(75.99,149.50)mmHg,1 mm Hg=0.133 kPa]和血红蛋白[(109.61±24.46)g/L]均显著低于非AKI组[134.50(105.36,156.57)mmHg和(121.24±21.77)g/L];AKI组的N端脑利钠肽[3148.28(446.42,13572.58)ng/L]、降钙素原[1480(560,8420)ng/L]、部分活化凝血活酶时间[39.80(34.42,45.32)s]和天冬氨酸氨基转移酶[38.00(21.00,66.50)U/L]均显著高于非AKI组[502.41(171.50,1703.00)ng/L、0.37(110,1040)ng/L、36.95(32.70,42.20)s、34.00(20.50,53.00)U/L],并且其血尿素氮[13.86(8.68,18.70)mmol/L]、血肌酐[177.00(90.30,375.00)μmol/L]和胱抑素C[2.67(1.77,4.08)mg/L]均显著高于非AKI组[7.31(5.51,9.67)mmol/L、62.95(51.75,78.10)μmol/L、1.34(1.10,1.61)mg/L](均P<0.05)。多因素Logistic回归分析结果显示,SOFA评分高、合并细菌感�Objective To screen the risk factors of acute kidney injury(AKI)in severe COVID-19 patients,construct a predictive model and explore its predictive value.Methods From December 1,2022 to July 1,2023,the relevant clinical data were retrospectively reviewed for 150 patients of severe COVID-19.Based upon the presence or absence of AKI,they were assigned into two groups of AKI(n=54)and non-AKI(n=96).Multivariate Logistic regression analysis was utilized for screening the risk factors for AKI in severe COVID-19 patients.A prediction model was constructed.And predictive value of model was verified by receiver operating characteristic curve(ROC).Results Age was significantly lower in AKI group than that in non-AKI group[74.50(63.00,81.50)vs 75.00(70.00,83.00)year].Proportion of AKI plus chronic obstructive pulmonary disease(1.85%)and proportion on high-flow nasal cannula(HFNC)(38.89%)were significantly lower than those in non-AKI group(13.54%,58.33%)(both P<0.05).Scores of APACHEⅡ[20.50(15.00,25.00)]and sequential organ failure assessment(SOFA)[8.00(6.00,10.00)]were significantly higher in AKI group than those in non-AKI group[16.00(13.00,18.25),5.00(4.00,6.00)].Proportion of patients with bacterial infection(61.11%)and receiving invasive ventilation therapy(57.41%)were significantly higher in AKI group than those in non-AKI group(40.62%,25.00%)(both P<0.05).Oxygenation index[109.55(75.99,149.50)mmHg(1 mm Hg=0.133 kPa)]and hemoglobin[(109.61±24.46)g/L]were significantly lower in AKI group than those in non-AKI group[134.50(105.36,156.57)mmHg and(121.24±21.77)g/L].N-terminal brain natriuretic peptide[3148.28(446.42,13572.58)ng/L],procalcitonin[1.48(0.56,8.42)ng/L],partially activated thromboplastin time[39.80(34.42,45.32)second]and aspartate aminotransferase[38.00(21.00,66.50)U/L]were significantly higher in AKI group than those in non-AKI group[502.41(171.50,1703.00)ng/L,370(110,1040)ng/L,36.95(32.70,42.20)second,34.00(20.50,53.00)U/L].Blood urea nitrogen[13.86(8.68,18.70)mmol/L],serum creatinine[177.00(90.30,375.00)

关 键 词：新型冠状病毒肺炎 急性肾损伤 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统] R692[医药卫生—内科学]