接受CRRT的ICU脓毒症患者预后因素分析

Analysis of Prognostic Factors in Sepsis Patients Receiving CRRT in ICU

摘要: 背景：脓毒症作为一种由感染引起的严重疾病，表现为全身性炎症反应综合征。CRRT作为ICU重要的治疗手段之一，被广泛用于脓毒症患者体内炎性因子清除，但是目前缺乏有关CRRT对于脓毒症患者预后影响的研究。目的：探讨CRRT对ICU脓毒症患者预后及影响。方法：回顾性分析2014年1月至2023年7月在我院ICU收治的125例脓毒症患者，根据是否接受CRRT治疗将患者分为CRRT组(n = 58)和非CRRT组(n = 67)。比较两组患者在治疗前后炎症指标(如NLR、CRP、PCT)、肾功能标志物(Cre)、凝血功能指标(PTA)以及心肌标志物(NT-proBNP)水平的差异，并分析了上述指标与28天死亡率的相关性。结果：与非CRRT组相比，CRRT组患者在治疗前血清Cre和NT-proBNP水平较高，而治疗后血清PCT和CRP水平较高。治疗前后，CRRT组患者的PTA水平均较非CRRT组低。Spearman等级相关分析显示，接受CRRT治疗的患者的28天死亡率与炎症指标(PCT, CRP)及心肌标志物(NT-proBNP)水平呈正相关。多因素Logistic回归分析进一步证实了PCT是影响CRRT组患者28天死亡率的独立危险因素。结论：心、肾功能不全是导致ICU脓毒症患者需要CRRT的主要原因，但影响患者临床预后的关键仍是炎症指标水平，CRRT不能完全扭转这类患者的结局。

Abstract: Background: Sepsis is a serious disease caused by infection and manifests as systemic inflammatory response syndrome. As one of the important treatments in the ICU, CRRT is widely used to clear inflammatory factors in patients with sepsis. However, there is currently a lack of research on the impact of CRRT on the prognosis of patients with sepsis. Objective: To explore the impact of CRRT on the prognosis and related clinical indicators of patients with sepsis. Method: A retrospective analysis was conducted on 125 sepsis patients admitted to the ICU of our hospital from January 2014 to July 2023. Patients were divided into a CRRT group (n = 58) and a non-CRRT group (n = 67) based on whether they received CRRT treatment. Differences in inflammatory indicators (such as NLR, CRP, and PCT), renal function markers (Cre), coagulation function indicators (PTA), and myocardial markers (NT-proBNP) levels between the two groups were compared before and after treatment. Additionally, the correlation between these indicators and 28-day mortality was analyzed. Results: Compared with the non-CRRT group, patients in the CRRT group had higher serum Cre and NT-proBNP levels before treatment, and higher serum PCT and CRP levels after treatment. Before and after treatment, the PTA levels of patients in the CRRT group were lower than those in the non-CRRT group. Spearman rank correlation analysis showed that the 28-day mortality of patients receiving CRRT was positively correlated with the levels of inflammatory markers (PCT, CRP) and myocardial markers (NT-proBNP). Multiple Logistic regression analysis further confirmed that PCT was an independent risk factor affecting the 28-day mortality of patients in the CRRT group. Conclusion: Cardiac and renal insufficiency are the main reasons why sepsis patients in ICU require CRRT. However, the key to affecting the clinical prognosis of patients is still the level of inflammatory indicators. CRRT cannot completely reverse the final outcome of these patients.