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目的探讨影响多器官功能障碍综合征(MODS)合并急性肾损伤(AKI)连续性血液净化治疗(CRRT)预后的相关因素,以及评价急性肾损伤分期标准(RIFLE)作为预后判断的临床价值。方法收集2004年1月至2008年2月行CRRT的184例合并AKI的MODS患者临床资料,采用logistic多因素方法回归分析其预后的影响因素,并着重以单因素分析RIFLE标准、急性生理学与慢性健康状态Ⅱ(APACHEⅡ)评分、治疗用药等临床信息,结合两者分析结果而判断预后影响因素。结果①全部患者病死率为54.3%,AKIⅠ期、Ⅱ期、Ⅲ期病死率分别为44.4%、63.6%、54.7%。AKI各期病死率差异无统计学意义(P>0.05)。②器官衰竭数未随AKI分期的加重而增多。患者病死率随着器官衰竭数的增加而增多(r=0.555,P=0.000)。③治疗前器官衰竭数(≥4个)(OR=10.671,95%CI3.841～29.644)、APACHEⅡ评分(>20)(OR=5.639,95%CI1.444～22.022)、医院获得性AKI(OR=3.030,95%CI1.321～6.950)以及需使用多巴胺(OR=7.744,95%CI2.450～24.472)是影响预后的独立危险因素。单因素分析提示年龄(>60岁)亦是危险因素之一(OR=2.03,95%CI为1.12～3.66)。结论①RIFLE标准有重要的临床价值,但其在预判MODS并AKI患者CRRT预后方面有一定的局限性;②治疗前器官衰竭数(≥4个)、APACHEⅡ评分(>20)、年龄(>60岁)、需使用多巴胺、医院获得性AKI是影响预后的危险因素。
Objective To investigate the related factors that affect the prognosis of multiple organ dysfunction syndrome (MODS) complicated with acute renal injury (AKI) with continuous blood purification (CRRT) and to evaluate the clinical value of RIFLE as a prognostic factor. Methods The clinical data of 184 patients with MODS complicated with AKI who underwent CRRT from January 2004 to February 2008 were collected. The prognostic factors were analyzed by logistic regression analysis. The single factor analysis of RIFLE criteria, acute physiology and chronic Health status Ⅱ (APACHE Ⅱ) score, clinical medication and other clinical information, combined with the analysis of the two to determine the prognostic factors. Results The mortality of all patients was 54.3%. The mortality rates of stage Ⅰ, stage Ⅱ and stage Ⅲ of AKI were 44.4%, 63.6% and 54.7%, respectively. There was no significant difference in mortality between AKI stages (P> 0.05). ② organ failure did not increase with the aggravation of AKI staging. Patient mortality increased with the number of organ failure (r = 0.555, P = 0.000). ③ The number of organ failure before treatment (≥4) (OR = 10.671,95% CI3.841 ~ 29.644), APACHEⅡscore (≥20) (OR = 5.639,95% CI1.444-22.022), hospital-acquired AKI OR = 3.030,95% CI1.321 ~ 6.950) and the need for dopamine (OR = 7.744,95% CI 2.450 ~ 24.472) were independent risk factors for prognosis. Univariate analysis suggested that age (> 60 years) was also a risk factor (OR = 2.03, 95% CI 1.12-3.66). Conclusion ① The RIFLE standard has important clinical value, but it has some limitations in predicting the prognosis of MODS and AKI. ②The number of organ failure (≥4), APACHEⅡ (≥20), age (> 60) Year), need to use dopamine, hospital-acquired AKI is a risk factor for prognosis.