基层医院急性心衰患者急性肾损伤的流行病学分析

摘要

目的 分析基层医院急性心衰患者急性肾损伤(AKI)发生的流行病学特点、预后及相关危险因素,为临床更好地早期预防心衰患者发生AKI及改善其预后提供理论依据.方法 选择2016年1月至12月住院并诊断为急性心力衰竭的患者,筛选AKI患者组成研究对象,回顾性分析AKI的发生情况、分布特点、病因及预后,Logistic回归分析影响AKI不良预后的相关危险因素.结果 符合入选标准的患者共161人,AKI在心衰患者中发生率为7.28%,男女比例为1.24:1,平均年龄(68.95±10.6)岁,发病率随年龄的增加逐渐升高.患者AKI后病死率为11.2%,肾脏存活率为79.5%.AKI-I、II、III期患者病死率分别为2.56%,9.26%,37.9%,多因素Logistic逐步回归模型分析显示:合并糖尿病(OR=1.323),合并慢性肾脏病(CKD)(OR=1.689),少尿史(OR=1.721)及需行肾脏替代治疗(RRT)(OR=2.585)是急性心衰后AKI患者肾脏丢失的独立危险因素,存在肾外器官衰竭(OR=1.636)及需行RRT(OR=1.918)是AKI患者死亡的独立危险因素.结论 AKI在急性心衰患者中常见,发病率随年龄的增加逐渐升高,可以造成中重度肾功能损伤,其预后与AKI分期密切相关,合并糖尿病,合并CKD,少尿史及需行RRT是急性心衰后AKI患者肾脏丢失的独立危险因素,存在肾外器官衰竭及需行RRT是AKI患者死亡的独立危险因素.%Objective To analyze the epidemiological feature,prognosis and risk factors of acute kidney injury(AKI)in patients with acute heart failure for better preventing and improving the prognosis.Methods All patients with AKI and acute heart failure were selected in our hospital Department of Cardiology from January 2016 to December. The incidence,distribution characteristics,etiology and prognosis of AKI were retrospectively analyzed. Logistic regression analysis was used to investigate related risk factors of adverse outcome.Results A total of 161 cases were enrolled. The incidence of AKI in patients with heart failure was 7.28%,the ratio of male to female was 1.24:1,the average age was(68.95±10.6)years old,the incidence rate increased gradually with age rising. The mortality was 11.2% in patients after AKI,the renal survival rate was 79.5%.The mortality rate was 2.56%,9.26% and 37.9% respectively among patients with stage AKI-I,II,III.Multivariate Logistic regression analysis showed that diabetes(OR=1.323),chronic kidney disease(CKD) (OR=1.689),oliguria(OR=1.721)and requiring renal replacement therapy(RRT)(OR=2.585)were independent risk factors for kidney loss. Failure organs except kidney(OR=1.636)and requiring RRT(OR=1.918)were independent risk factors for death in AKI patients with acute heart failure. Conclusion AKI is common in patients with acute heart failure,the incidence rate increases with the rising of age,AKI can cause severe renal injury and its prognosis is closely correlated with stages.Diabetes,CKD,oliguria and requiring RRT are independent risk factors for kidney loss. Failure organs except kidney and requiring RRT are independent risk factor for death.