脓毒症内科重症监护室患者新发急性肾损伤的相关因素和结果。

Northern clinics of Istanbul Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI:10.14744/nci.2024.30040
Kamil Inci, Gulbin Aygencel, Nazlihan Boyaci Dundar, Ozant Helvaci, Melda Turkoglu
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引用次数: 0

摘要

目的:脓毒症诱发的急性肾损伤(AKI)是一个重大威胁,会导致重症监护病房(ICU)患者的预后恶化。因此,了解脓毒症与 ICU 患者肾功能障碍之间的复杂关系至关重要。本研究旨在探讨脓毒症内科重症监护病房患者新发 AKI 的诱发因素和临床后果:这项回顾性队列研究于 2019 年 12 月至 2023 年 4 月期间在土耳其安卡拉加齐大学医院的三级内科 ICU 进行。参与者包括年龄≥18 岁、入院时无 AKI 的脓毒症内科 ICU 患者。数据包括人口统计学、合并症、疾病严重程度和预后评分、ICU入院和ICU随访数据。研究人员进行了包括逻辑回归在内的统计分析,以确定新发 AKI 发生和 ICU 死亡率的独立风险因素:结果:新发 AKI 患者(发生率为 36%)入 ICU 时的 APACHE-II 评分(21 [16-27] vs. 16 [12-18])和 SOFA 评分(6 [3-9] vs. 3 [2-5])较高,GCS 评分(10 [6-15] vs. 14 [10-15])较低(p 结论:该研究揭示了新发 AKI 的风险因素:本研究显示,脓毒症内科 ICU 患者新发 AKI 的发生率为 36%。此外,研究还强调了感染源对新发 AKI 的潜在影响。在这一人群中,新发休克、IMV和疾病严重程度与新发AKI和ICU死亡率均有独立关联。
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Factors and outcomes related to new-onset acute kidney injury in septic medical intensive care unit patients.

Objective: Sepsis-induced acute kidney injury (AKI) is a significant threat, contributing to worse outcomes in intensive care unit (ICU) patients. Thus, understanding the complex relationship between sepsis and renal dysfunction in ICU patients is crucial. We aimed to investigate the factors that may predispose to the development and the clinical consequences of new-onset AKI in septic medical ICU patients in this study.

Methods: This retrospective cohort was conducted between December 2019 and April 2023 in the tertiary medical ICU of Gazi University Hospital, Ankara, Turkiye. Participants included septic medical ICU patients aged ≥18 without AKI on ICU admission. Data included demographics, comorbidities, disease severity and prognostic scoring, ICU admission, and ICU follow-up data. Statistical analyses, including logistic regression, were performed to identify independent risk factors for new-onset AKI development and ICU mortality.

Results: Patients with new-onset AKI (36% incidence) had higher APACHE-II (21 [16-27] vs. 16 [12-18]) and SOFA (6 [3-9] vs. 3 [2-5]) scores and lower GCS (10 [6-15] vs. 14 [10-15]) on ICU admission (p<0.01 for all results). Independent risk factors for both new AKI development and ICU mortality included invasive mechanical ventilation (IMV) (OR (95% CI): 5.02 [1.59-15] for AKI and OR (95% CI): 13.2 [3-58.8] for ICU mortality, p<0.01), new-onset shock (OR (95% CI): 3.98 [1.42-11.1] for AKI, OR (95% CI): 14.5 [4.4-43.5] for mortality, p<0.01), and higher APACHE-II score (OR (95% CI): 1.08 [1.01-1.16]), for AKI, p=0.05 and (OR (95% CI): 1.04 [1.01-1.08], for mortality, p=0.01). AKI was more frequent in patients whose source of infection was the respiratory system (45% vs. 29%, p=0.01) and catheter-related bloodstream infection (CRBSI) (17% vs. 8%, p=0.03) than those who did not. New AKI development was associated with longer ICU stay (9 [5-18] vs. 5 [3-10] days, p<0.01) and was independently associated with ICU mortality (OR (95% CI): 28.6 [6.6-125], p<0.01).

Conclusion: This study reveals new-onset AKI incidence of 36% in septic medical ICU patients. Additionally, it underlines the potential impact of infection sources on new AKI development. New-onset shock, IMV, and disease severity were independently associated with both new-onset AKI and ICU mortality in this population.

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