住院超高龄患者急性肾损伤发病后死亡相关因素分析

Related factors analysis of death after acute kidney injury in hospitalized elderly patients

摘要:

目的 分析住院超高龄患者急性肾损伤（AKI）发病后死亡相关因素。方法 回顾性分析2016年1月— 2018年1月三亚市人民医院收治的住院超高龄患者513例。其中200例患者住院期间发生AKI，出院12个月内死亡67例（死亡组），存活133例（存活组）。分析患者死亡原因，单因素和Logistic多因素分析住院超高龄患者AKI发病后死亡的相关因素。结果 脓毒症、休克、心功能不全、肾毒性药物为患者死亡的主要原因。经单因素分析，死亡组和存活组患者的年龄、体重指数（BMI）、基础疾病、AKI病因、肾小球滤过率（GFR）、平均动脉压、机械通气、尿量<0.05?ml/（kg·h）、AKI发生时各指标、AKI类型和AKI分期的差异有统计学意义（P?<0.05）。死亡组患者较存活组年龄高、BMI低、高血压发生率低、低血压和高尿酸血症发生率高，感染所致AKI发生率高，肾毒性药物所致AKI发生率低，GFR水平高，AKI发生时平均动脉压低，机械通气和尿量<0.05?ml/（kg·h）发生率高，尿酸、Scr峰值、Scr、尿素氮、血钙、血磷水平较高，血清前白蛋白、血红蛋白、血镁水平较低，AKI多为持续型，多为Ⅲ期患者，住院时间较长。Logistic多因素分析结果显示，高龄、低血压、伴发感染、平均动脉压降低、尿量<0.05?ml/（kg·h）、尿素氮升高、血清前白蛋白降低、高AKI分期、住院时间长为住院超高龄患者AKI发病后死亡的危险因素（P?<0.05）。结论 高龄、低血压、伴发感染、平均动脉压降低、尿量<0.05?ml/（kg·h）、尿素氮升高、血清前白蛋白降低、高AKI分期、住院时间长为住院超高龄患者AKI发病后死亡的危险因素，临床中应加强对此类患者的监控，以提高患者生存率。

Abstract:

Objective To analyze the related factors of death after acute kidney injury (AKI) in hospitalized elderly patients. Methods The clinical data of 513 inpatients with super-aged patients admitted to our hospital from January 2016 to January 2018 were retrospectively analyzed. Among them, 200 patients developed acute kidney injury during hospitalization. Within 12 months after discharge, 67 patients died and 133 patients survived. Death causes of the patient were analyzed, and the single factor and Logistic multivariate analysis were used to analyze the factors associated with death after AKI in hospitalized patients. Results Sepsis, shock, cardiac insufficiency and nephrotoxic drugs were the main causes of death. Univariate analysis showed age, body mass index (BMI), underlying disease, AKI etiology, glomerular filtration rate (eGFR), creatinine (Scr), mean arterial pressure, mechanical ventilation, urine volume < 0.05?ml/(kg?h), differences of AKI, AKI type and AKI stage were statistically significant (P?