Risk factors for renal failure and short-term prognosis in patients with spontaneous intracerebral haemorrhage complicated by acute kidney injury
Risk factors for renal failure and short-term prognosis in patients with spontaneous intracerebral haemorrhage complicated by acute kidney injury
复制标题
自发性脑出血并发急性肾损伤患者肾功能衰竭的危险因素及近期预后
DOI：
10.1186/s12882-020-01949-9
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发表时间：
2020-07-29
期刊：
影响因子：
2.3
通讯作者：
Xu，Yanfang
中科院分区：
文献类型：
--
作者：
Zou，Zhenhuan;Chen，Siying;Xu，Yanfang
背景虽然急性肾损伤(AKI)是自发性脑出血(SICH)患者不良临床结局的危险因素，但在SICH合并AKI的情况下，导致肾功能衰竭和短期预后的易感因素却知之甚少。方法对福建医科大学附属第一医院2016年1月至2018年12月收治的543例SICH合并不同程度AKI患者进行回顾性研究。应用Logistic回归和受试者算子特征(ROC)曲线分析确定最佳预测变量和判别变量。结果在多因素校正模型中，高血钠、代谢性酸中毒、血清肌酸激酶升高、高尿酸血症、蛋白尿、胶体和利尿剂的使用均是SICH患者发生3期AKI的独立危险因素。曲线下面积分析表明，高钠血症和高尿酸血症是3期AKI的预测因素，这两个参数的组合增加了3期AKI的预测性。Kaplan-Meier生存曲线显示1期和2期AKI的SICH患者的肾脏恢复率显著高于3期AKI的SICH患者。多因素Cox回归分析显示，高钠血症和发生3期AKI是近期肾功能恢复不良的预测因素。结论高钠血症和高尿酸血症是SICH患者发生3期AKI的潜在危险因素。高钠血症和3期AKI患者肾功能恢复的近期预后较差。
BackgroundAlthough acute kidney injury (AKI) is a known risk factor for adverse clinical outcomes in patients with spontaneous intracerebral haemorrhage (SICH), little is known about the predisposing factors that contribute to renal failure and short-term prognosis in the setting of SICH already complicated by AKI. In this study, we aimed to identify the renal failure factors in SICH patents with AKI.MethodsFive hundred forty-three patients with SICH complicated by differential severities of AKI who were admitted to the First Affiliated Hospital of Fujian Medical University from January 2016 to December 2018 were retrospectively studied. Logistic regression and receiver operator characteristic (ROC) curve analysis were performed to determine the best predictive and discriminative variables. Multivariate Cox regression analysis was performed to identify prognostic factors for renal recovery.ResultsIn the multivariable adjusted model, we found that hypernatremia, metabolic acidosis, elevated serum creatine kinase, hyperuricaemia, proteinuria, and the use of colloids and diuretics were all independent risk factors for the occurrence of stage 3 AKI in SICH patients. The area under the curve analysis indicated that hypernatremia and hyperuricaemia were predictive factors for stage 3 AKI, and the combination of these two parameters increased their predictability for stage 3 AKI. Kaplan-Meier survival curves revealed that the renal recovery rate in SICH patients with stages 1 and 2 AKI was significantly higher than that in SICH patients with stage 3 AKI. Multivariate Cox regression analysis suggested that hypernatremia and the occurrence of stage 3 AKI are predictors for poor short-term renal recovery.ConclusionsThese findings illustrate that hypernatremia and hyperuricaemia represent potential risk factors for the occurrence of stage 3 AKI in SICH patients. Those patients with hypernatremia and stage 3 AKI were associated with a poor short-term prognosis in renal recovery.