良性胸腔积液患者发生急性肾损伤的临床特征和预测因素

王丹妮; 牛越; 陈丁华; 李超凡; 方清云; 曹雪莹; 张利; 孙雪峰; 蔡广研; 李平; 陈香美

doi:10.12435/j.issn.2095-5227.2023.127

良性胸腔积液患者发生急性肾损伤的临床特征和预测因素

Characteristics and predictors of acute kidney injury in patients with nonmalignant pleural effusions

摘要

摘要:
背景既往小样本的研究提示胸腔积液可能是急性肾损伤(acute kidney injury，AKI)的危险因素。良性胸腔积液(nonmalignant pleural effusion，NMPE)患者中AKI的发生情况及其预测因素尚不清楚。
目的探讨伴有NMPE的住院患者中AKI的发生情况及其预测因素。
方法纳入解放军总医院2018年1月1日—2021年12月31日住院期间行影像学检查、报告提示为胸腔积液的内科住院患者。排除恶性肿瘤、规律透析、终末期肾病、行影像学检查之前发生AKI以及住院期间血清肌酐测量少于2次的患者。采集患者的临床和治疗信息，描述不同科室和不同诊断的患者院内AKI发生率，使用LASSO-Logistic回归筛选AKI的预测因素。
结果共纳入3047例患者，其中360例发生院内AKI (11.8%)。LASSO-Logistic回归显示，胸腔积液量、机械通气、重症监护室(ICU)、万古霉素/替考拉宁、血管活性药物、螺内酯、袢利尿剂、非甾体抗炎药、低估算肾小球滤过率(estimated glomerular filtration rate，eGFR)、低血小板、高白细胞计数和蛋白尿是院内AKI发生的独立预测因子，与少量胸腔积液患者相比，中量和大量胸腔积液患者发生院内AKI的可能性更高(中量：OR=1.47，95% CI：1.11 ~ 1.94，P=0.006；大量：OR=1.86，95% CI：1.05 ~ 3.20，P=0.028)。
结论良性胸腔积液患者院内AKI发生率为11.8%，与少量积液相比，中量、大量积液与院内AKI的发生独立相关。除此以外，机械通气、ICU、万古霉素/替考拉宁、血管活性药物、螺内酯、袢利尿剂、非甾体抗炎药、低eGFR、低血小板、高白细胞计数和蛋白尿是住院期间发生AKI的独立预测因素。

Abstract:
Background Previous small-sample studies have suggested that pleural effusion may be a risk factor for acute kidney injury (AKI). However, the incidence and predictors of AKI in nonmalignant pleural effusion (NMPE) patients remain unclear.
Objective To assess the incidence and predictors of AKI in NMPE inpatients.
Methods A retrospective study of inpatients with pleural effusions admitted to Chinese PLA General Hospital from 2018 to 2021 was conducted based on the electronic medical records. All patients with pleural effusions confirmed by chest radiography (CT or X-ray) were included, excluding diagnosis of malignancy, maintenance dialysis, end-stage renal disease, AKI before chest radiography and those with serum creatinine tests being less than twice. The incidence of hospital-acquired AKI (HA-AKI) was described according to different departments and diagnoses. LASSO-logistic regression model was used to identify predictors of HA-AKI.
Results Totally 3047 cases met the inclusion criteria. Among them, there were 360 cases (11.8%) of HA-AKI. After selected by LASSO-logistic regression, pleural effusion volume, mechanical ventilation, ICU admission, vancomycin/teicoplanin, vasoactive drugs, spironolactone, loop diuretics, non-steroidal anti-inflammatory drugs, low eGFR, low platelets, high white blood cell count, and proteinuria were independent predictors of HA-AKI. Patients with moderate and large pleural effusions were more likely to develop AKI in hospital compared to patients with small effusions (moderate: OR=1.47, 95% CI: 1.11-1.94, P=0.006; large: OR=1.86, 95% CI: 1.05-3.20, P=0.028).
Conclusion The incidence of HA-AKI is 11.8% among NMPE patients, and large effusion volume is independently associated with HA-AKI. In addition, mechanical ventilation, ICU admission, vancomycin/teicoplanin, vasoactive drugs, spironolactone, loop diuretics, non-steroidal anti-inflammatory drugs, low eGFR, low platelets, high white blood cell count, and proteinuria are independent predictors of HA-AKI during hospitalization.

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