合并慢性肾脏病的脓毒症患者28天死亡的危险因素分析

Analysis of Risk Factors for 28-Day Death in Sepsis Patients with Chronic Kidney Disease

摘要: 目的：探讨慢性肾脏病合并脓毒症患者的临床特征并分析短期内死亡的危险因素。方法：以MIMIC-IV数据库作为数据来源，选取慢性肾脏病合并脓毒症患者(4288例)，收集患者临床资料，根据患者28天预后情况分为存活组(3379例)与死亡组(909例)。应用秩和检验及卡方检验分析死亡组和存活组的临床特征差异，采用Lasso逻辑回归方法及logistic回归分析方法分析慢性肾脏病合并脓毒症患者短期内死亡的独立危险因素。结果：4288例患者中，909例患者在28天内死亡，死亡率为21.20%。存活组与死亡组差异性比较结果显示，两组间的年龄、体重、查尔森合并症指数、SOFA、APSIII、GCS、心率、收缩压、平均动脉压、呼吸频率、体温、血氧饱和度、血糖、红细胞压积、红细胞分布宽度、白细胞计数、阴离子间隙、碳酸氢根、尿素氮、氯离子、肌酐、钾离子、国际标准化比值、凝血酶原时间、活化部分凝血活酶时间、是否使用机械通气及是否使用血管活性药物的差异均有统计学意义(均为P < 0.05)。通过Lasso逻辑回归及logistic回归分析，结果显示，年龄(OR = 1.04, P < 0.001)、体重(OR = 0.99, P < 0.001)、查尔森合并症指数(OR = 1.14, P < 0.001)、APSIII评分(OR = 1.04, P < 0.001)、GCS (OR = 1.05, P = 0.005)、呼吸频率(OR = 1.03, P < 0.001)、SpO₂ (OR = 0.98, P = 0.044)、红细胞压积(OR = 1.03, P < 0.001)、RDW (OR = 1.14, P < 0.001)及PTT (OR = 1.01, P = 0.003)是慢性肾脏病合并脓毒症患者短期内死亡的独立危险因素。

Abstract: Objective: To investigate the clinical features of patients with chronic kidney disease and sepsis and to analyze the risk factors for death in the short term. Methods: A total of 4288 patients with chronic kidney disease and sepsis were selected from the MIMIC-IV database, and the clinical data of the patients were collected and divided into survival group (3379 cases) and death group (909 cases) according to the 28-day prognosis. The rank sum test and chi-square test were used to analyze the differences in clinical characteristics between the death group and the survival group, and the Lasso logistic regression method and logistic regression analysis were used to analyze the independent risk factors for short-term death in patients with chronic kidney disease complicated with sepsis. Results: Among the 4288 patients, 909 patients died within 28 days, with a mortality rate of 21.20%. The results of the comparative analysis between the survival group and the death group revealed statistically significant differences in age, body weight, Charlson Comorbidity Index, SOFA score, APSIII score, Glasgow Coma Scale (GCS), heart rate, systolic blood pressure, mean arterial pressure, respiratory rate, body temperature, blood oxygen saturation, blood glucose, hematocrit, red blood cell distribution width, white blood cell count, anion gap, bicarbonate, blood urea nitrogen, chloride, creatinine, potassium, international normalized ratio (INR), prothrombin time, activated partial thromboplastin time, mechanical ventilation use, and vasopressor use (all P < 0.05). The results showed that age (OR = 1.04, P < 0.001), weight (OR = 0.99, P < 0.001), Charleson comorbidity index (OR = 1.14, P < 0.001), APSIII score (OR = 1.04, P < 0.001), GCS (OR = 1.05, P = 0.005), respiratory rate (OR = 1.03, P < 0.001), SpO₂ (OR = 0.98, P = 0.044), and hematocrit (OR = 1.03, P < 0.001), RDW (OR = 1.14, P < 0.001) and PTT (OR = 1.01, P = 0.003) were independent risk factors for short-term mortality in patients with chronic kidney disease and sepsis.