终末期肾病患者透析期间脑出血的危险因素及其对短期预后的影响

Risk factors for intracerebral hemorrhage during dialysis in patients with end-stage renal disease and its impact on short-term prognosis

摘要:

目的 分析终末期肾病患者透析期间脑出血的危险因素及其对短期预后的影响。方法 选取2023年1月—2026年1月于丽水市第二人民医院和丽水市中心医院行维持性透析的终末期肾病患者150例，根据透析期间是否发生脑出血分为脑出血组（41例）和非脑出血组（109例）。比较两组临床资料，进行多因素一般Logistic回归分析筛选脑出血的危险因素，并采用受试者工作特征（ROC）曲线评估其预测效能。随访3个月，记录患者预后情况。结果 脑出血组糖尿病患病率、平均收缩压、血钠水平均高于非脑出血组，透析时间均长于非脑出血组，血清白蛋白水平、血红蛋白水平均低于非脑出血组（P <0.05）。多因素一般Logistic回归分析结果显示：透析时间长［O^R=1.207（95% CI：1.093，1.333）］、血钠水平高［O^R=1.714（95% CI：1.303，2.256）］均是终末期肾病患者透析期间发生脑出血的危险因素（P <0.05），血清白蛋白水平高［O^R=0.629（95% CI：0.495，0.800）］、血红蛋白水平高［O^R=0.759（95% CI：0.660，0.874）］均是终末期肾病患者透析期间发生脑出血的保护因素（P <0.05）。ROC曲线分析结果显示，血钠水平、透析时间、血清白蛋白水平、血红蛋白水平联合检测预测终末期肾病患者透析期间发生脑出血的敏感性为92.7%（95% CI：0.801，0.985），特异性为84.4%（95% CI：0.762，0.906），曲线下面积为0.951（95% CI：0.920，0.983）。结论 高血钠水平、透析时间长是脑出血的独立危险因素，高血清白蛋白水平、高血红蛋白水平是脑出血的保护因素；上述指标联合检测对终末期肾病患者透析期间发生脑出血风险具有较高的预测效能。一旦并发脑出血，患者短期预后较差，临床应针对上述指标强化干预以改善预后。

Abstract:

Objective To analyze the risk factors for intracerebral hemorrhage (ICH) during dialysis in patients with end-stage renal disease (ESRD) and its impact on short-term prognosis.Methods A retrospective analysis was conducted on 150 ESRD patients undergoing maintenance dialysis at Lishui Second People's Hospital and Lishui Central Hospital from January 2023 to January 2026. Patients were divided into an ICH group (n = 41) and a non-ICH group (n = 109) based on whether ICH occurred during dialysis. Clinical data were compared between the two groups. Indicators with statistical significance were included in a multivariable logistic regression analysis to screen for independent risk factors. The predictive efficacy was evaluated using the receiver operating characteristic (ROC) curve. Patients were followed up for 3 months to record their prognoses.Results Compared with the non-ICH group, the ICH group had a significantly higher proportion of diabetes mellitus, higher mean systolic blood pressure, higher serum sodium levels, longer dialysis duration, and lower serum albumin and hemoglobin levels (all P < 0.05). Multivariate logistic regression analysis showed that dialysis duration [O^R = 1.207 (95% CI: 1.093, 1.333) ] and serum sodium level [O^R = 1.714 (95% CI: 1.303, 2.256) ] were independent risk factors for ICH during dialysis in patients with end-stage renal disease, whereas serum albumin level [O^R = 0.629 (95% CI: 0.495, 0.800) ] and hemoglobin level [O^R = 0.759 (95% CI: 0.660, 0.874) ] were protective factors. ROC curve analysis demonstrated that the combination of serum sodium level, dialysis duration, serum albumin level, and hemoglobin level for predicting ICH during dialysis in patients with end-stage renal disease yielded a sensitivity of 92.7% (95% CI: 0.801, 0.985), a specificity of 84.4% (95% CI: 0.762, 0.906), and an area under the curve (AUC) of 0.951 (95% CI: 0.920, 0.983).Conclusion Hypernatremia and prolonged dialysis duration are independent risk factors for ICH in ESRD patients, whereas high serum albumin and hemoglobin levels are protective factors. The combination of these indicators exhibits high predictive efficacy for ICH risk. Once ICH occurs, the short-term prognosis is poor; therefore, targeted interventions should be strengthened to improve patient outcomes.