重症肺炎患者体外膜肺氧合治疗并发急性肾损伤的危险因素分析

Analysis of risk factors for acute kidney injury complicated by ECMO treatment in patients with severe pneumonia

摘要:

目的 探讨重症肺炎（SP）患者接受体外膜肺氧合（ECMO）治疗并发急性肾损伤（AKI）的危险因素。方法 回顾性分析2022年1月—2025年1月在南方医科大学第十附属医院接受ECMO治疗的100例SP患者的临床资料。根据ECMO启动后7 d内是否发生AKI，分为AKI组（58例）与非AKI组（42例）。统计两组一般资料，通过多因素一般Logistic逐步回归模型和受试者工作特征（ROC）曲线确定SP患者ECMO治疗期间并发AKI的危险因素。结果 AKI组感染性休克发生率、血乳酸水平、降钙素原（PCT）水平及血管性血友病因子（vWF）水平均高于非AKI组（P <0.05）。多因素一般Logistic回归分析结果显示：有感染性休克［O^R=1.483（95% CI：1.115，1.972）］、血乳酸水平高［O^R=1.268（95% CI：1.089，1.476）］、PCT水平高［O^R=1.616（95% CI：1.221，2.139）］、vWF水平高［O^R=1.648（95% CI：1.217，2.232）］均为SP患者ECMO治疗期间并发AKI的危险因素（P <0.05）。ROC曲线分析结果显示，血乳酸、PCT、vWF预测SP患者ECMO治疗期间并发AKI的曲线下面积分别为0.887、0.928、0.925，敏感性分别为86.2%（95% CI：0.746，0.939）、89.6%（95% CI：0.788，0.961）、91.4%（95% CI：0.810，0.971），特异性分别为80.9%（95% CI：0.659，0.914）、88.1%（95% CI：0.744，0.960）、83.3%（95% CI：0.686，0.930）。结论 感染性休克、血乳酸水平、PCT水平及vWF水平均为SP患者ECMO治疗期间并发AKI的独立危险因素，临床应予以重点关注。

Abstract:

Objective To analyze the risk factors for acute kidney injury (AKI) in patients with severe pneumonia (SP) who received extracorporeal membrane oxygenation (ECMO) treatment.Methods This retrospective study included 100 patients with SP who received ECMO treatment at the Tenth Affiliated Hospital of Southern Medical University between January 2022 and January 2025. Based on whether AKI occurred within 7 days after ECMO initiation, all the enrolled patients were divided into two groups: the AKI group (58 cases) and the non-AKI group (42 cases). The general data of the two groups were statistically analyzed. Through multivariable logistic stepwise regression analysis and the receiver operating characteristic (ROC) curve, the risk factors for AKI during ECMO treatment in patients with SP were determined.Results The prevalence of septic shock and blood lactate, procalcitonin (PCT), and von Willebrand factor (vWF) levels were higher in the AKI group than in the non-AKI group (P < 0.05). Multivariable logistic regression analysis showed that septic shock [O^R = 1.483 (95% CI: 1.115, 1.972) ], elevated blood lactate [O^R = 1.268 (95% CI: 1.089, 1.476) ], elevated PCT [O^R = 1.616 (95% CI: 1.221, 2.139) ], and elevated vWF [O^R = 1.648 (95% CI: 1.217, 2.232) ] were risk factors for AKI during ECMO treatment in patients with SP (P < 0.05). The AUCs for blood lactate, PCT, and vWF were 0.887, 0.928, and 0.925, respectively. Their sensitivities were 86.2% (95% CI: 0.746, 0.939), 89.6% (95% CI: 0.788, 0.961), and 91.4% (95% CI: 0.810, 0.971), respectively, and their specificities were 80.9% (95% CI: 0.659, 0.914), 88.1% (95% CI: 0.744, 0.960), and 83.3% (95% CI: 0.686, 0.930), respectively.Conclusion Septic shock, blood lactate level, PCT level and vWF level are all independent risk factors for AKI in patients with SP during ECMO treatment. Clinicians should pay close attention to these factors.