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社区获得性肺炎伴发急性肾损伤的预后危险因素分析

李家瑞   

  1. 天津市天津医院急诊医学科
  • 收稿日期:2014-04-28 修回日期:2014-07-03 出版日期:2014-10-15 发布日期:2014-10-15
  • 通讯作者: 李家瑞

Analysis of Prognostic Risk Factors in Patients with Community Acquired Pneumonia Complicated with Acute Kidney Injury

LI Jia rui   

  1. Department of Emergency Medicine，Tianjin Hospital，Tianjin 300211，China
  • Received:2014-04-28 Revised:2014-07-03 Published:2014-10-15 Online:2014-10-15
  • Contact: LI Jia rui

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摘要：

【摘要】目的 探讨社区获得性肺炎（CAP）患者伴发急性肾损伤（AKI）的预后危险因素。方法 456 例CAP 患者为无伴发AKI（N-AKI）组和伴发AKI 组。AKI 组又根据RIFLE 的严重程度级别分为3 个亚组：危险（Risk）、损伤（Injury）和衰竭（Failure）组。比较各组患者CAP 的严重程度，各项临床指标和预后评估指标的差别；多因素分析采用Logistic 回归模型，生存分析采用Kaplan-Meier 法，分析影响CAP 患者预后不良的危险因素及RIFLE 标准在预后评估中作用。结果 456 例CAP 患者中有30%（135 例）伴发AKI，诊断为Risk 61 例（45.2%），Injury 23 例（17%）， Failure 51 例（37.8%）。CAP 患者PSI 评分为Ⅰ~Ⅲ级的患者（300 例）中有23.3%（70 例）伴发AKI，PSI 分级≥IV 的患者（156 例）中有41.7%（65 例）伴发AKI，差异有统计学意义（P < 0.01）。伴发AKI 的CAP 患者30 d 病死率随AKI 严重程度增加（N-AKI 患者6.2%，Risk 患者14.8%，Injury 患者21.7%，Failure 患者45.1%）。此外，随着AKI 严重程度增加，需要机械通气、正性肌力药物和肾脏替代治疗的患者比例增加。Logistic 回归分析显示合并AKI、>75 岁、合并肾外器官衰竭是住院CAP 患者预后不良的危险因素。结论 住院CAP 患者伴发AKI 的预后不良。RIFLE 诊断及分级标准可有效评估CAP 伴发AKI 患者的预后。

关键词: 社区获得性肺炎, 急性肾损伤, 预后, RIFLE分级

Abstract:

[Abstract] Objective  To explore clinical characteristics and prognostic risk factors in patients with community ac? quired pneumonia（CAP）complicated with acute kidney injury（AKI）．Methods  In total, 456 CAP patients were included based on the diagnostic guide．According to whether the patients were accompanied with AKI，the patients were divided in? to two groups（non-AKI group and AKI group）．AKI group were further divided into risk group, injury group and failure group by RIFLE criteria using admission creatinine．Severity in CAP patients，clinical indexes and prognostic evaluation in? dexes were compared between different groups． Multiple factors were analyzed using Logistic regression model，survival RIFLE criteria in prognostic evaluation．Results  Thirty percent（135）of the total 456 CAP patients were accompanied with AKI．Patients in AKI group were further divided into risked group (45.2%, 61 patients), injury group (17%, 23 pa? tients) and failure group (37.8%, 51 patients) according to the RIFLE diagnostic criteria using basal creatinine level. Among the 300 patients with PSI gradeⅠ to Ⅲ，23.3%（70）of patients developed AKI while among 156 patients who are with PSI grade Ⅳor over, 65 patients (41.7%) developed AKI（P < 0.01）．The 30-day mortality of CAP patients accompanied with AKI were increased compared to Non-AKI group（Non-AKI：6.2%；Risk：14.8%；Injury：21.7%；Failure：45.1%）．With de? teriorating in RIFLE criteria，the portion of patients who required mechanical ventilation, inotropic support（MV/IS）and re? nal replacement therapy（RRT）increased too. Logistic analysis revealed that AKI，age of 75 years or older and extra-renal or? gan failure were the risk factors of poor prognosis in patients with CAP. The rate of survivors was decreased in the CAP pa? tients accompanied with AKI compared with those who did not．Conclusion  There is certain incidence of AKI to compli? cate CAP patients who will have a poor prognosis．RIFLE diagnostic criteria is a valuable tool to evaluate prognosis of CAP patients complicated with AKI．

Key words: community acquired pneumonia, acute kidney injury (AKI), prognosis, RIFLE class