感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测  

Identification of risk factors for acute kidney injury in patients with infective endocarditis and prediction of death risk in such patients with acute kidney injury

作　　者：颜世锐 熊辉[1] Yan Shirui;Xiong Hui(Department of Emergency Medicine,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院急诊科,北京100034

出　　处：《中华临床医师杂志(电子版)》2024年第7期618-624,共7页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探索感染性心内膜炎(IE)合并急性肾损伤(AKI)患者的相关危险因素,并预测该群体住院期间的死亡风险,为临床治疗提供帮助。方法回顾性收集2014年1月1日至2023年12月31日在北京大学第一医院住院患者中出院诊断中含有“感染性心内膜炎”的成年患者,根据是否发生AKI分为AKI组与非AKI组,剔除明确由心脏手术引发的AKI病例,比较组间差异,探索AKI的危险因素。在已经合并AKI的群体中,分为死亡组与存活组,分析死亡相关的危险因素,并预测死亡风险。结果最终纳入131例患者,AKI组56人(其中明确由心脏手术引发的AKI12例),非AKI组75人,总AKI发生率42.7%,非手术相关AKI发生率33.6%。在总AKI群体中,死亡12人,病死率21.4%。糖尿病(OR=4.69,95%CI:1.03~21.47)、尿检异常(OR=5.79,95%CI:1.67~20.08)、应用造影剂(OR=5.68,95%CI:1.43~22.65)、脓毒症(OR=22.17,95%CI:4.75~103.53)是IE患者发生AKI发生的危险因素(P<0.05),而发生脓毒症(OR=42.79,95%CI:1.64~1114.70)和累及系统(或器官)数量(OR=4.44,95%CI:1.44~13.68)对IE合并AKI群体的住院死亡风险具有重要影响(P<0.05)。结论IE患者中,尿检异常、糖尿病、造影剂应用及发生脓毒症是AKI发生的危险因素。无论何时发生脓毒症、AKI后48 h受累系统(或器官)数量对IE合并AKI群体死亡有预测意义。Objective To identify the risk factors for acute kidney injury(AKI)in patients with infectious endocarditis(IE),and to predict the risk of death during hospitalization in such patients with AKI,so as to provide help for clinical treatment of these patients.Methods Adult patients hospitalized at Peking University First Hospital from January 1,2014 to December 31,2019 who were diagnosed with IE were retrospectively collected and divided into either an AKI group or a non-AKI group according to whether AKI occurred or not.AKI cases clearly caused by cardiac surgery were excluded.The two groups were compared for potential variables to identify the risk factors for AKI.The patients with AKI were then divided into either a death group or a survival group based on the outcome,and the risk factors associated with death were identified and the risk of death was predicted.Results A total of 131 patients were included,including 56 patients in the AKI group(including 12 AKI cases clearly caused by cardiac surgery)and 75 in the non-AKI group,with the total incidence of AKI and non-surgical AKI being 42.7%and 33.6%,respectively.In the total AKI population,12 people died and the case fatality rate was 21.4%.Diabetes(odds ratio[OR]=4.69,95%confidence interval[CI]:1.03~21.47),abnormal urine test(OR=5.79,95%CI:1.67~20.08),use of contrast medium(OR=5.68,95%CI:1.43~22.65),and sepsis(OR=22.17,95%CI:4.75~103.53)were identified to be the risk factors for AKI in IE patients(P<0.05),while sepsis(OR=42.79,95%CI:1.64~1114.70)and the number of systems(or organs)involved(OR=4.44,95%CI:1.44~13.68)had an important effect on the risk of in-hospital death in IE patients with AKI(P<0.05).Conclusion Abnormal urine test,diabetes mellitus,contrast agent use,and sepsis are risk factors for AKI in IE patients.No matter when sepsis occurs,the number of affected systems(or organs)at 48 hours after AKI is significant in predicting the death of IE patients with AKI.

关 键 词：感染性心内膜炎 急性肾损伤 死亡风险列线图 危险因素 

分 类 号：R54[医药卫生—心血管疾病]