社区获得性肺炎伴发急性肾损伤的预后危险因素分析

发布时间：2018-05-02 00:05

  本文选题：社区获得性肺炎 + 急性肾损伤　； 参考：《天津医药》2014年10期

【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(P0.01)。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。
[Abstract]:Objective to investigate the prognostic risk factors of acute renal injury (AKI) in patients with community-acquired pneumonia (CAP). Methods 456 patients with CAP were divided into three subgroups according to the severity of RIFLE: the group without AKIN-AKI and the group with AKI. The severity of CAP, clinical indexes and prognostic evaluation indexes were compared among the three groups. Logistic regression model was used for multivariate analysis and Kaplan-Meier method was used for survival analysis. To analyze the risk factors of poor prognosis in patients with CAP and the role of RIFLE criteria in prognosis evaluation. Results of the 456 patients with CAP, 30135 were associated with AKI, and 61 patients with Risk were diagnosed as having 45.2fibronectomies. Twenty-three of the 51patients with PSI grade 鈪，

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