影响新生儿早发型败血症相关急性肾损伤预后危险因素分析

Analysis of Risk Factors for the Prognosis of Neonatal Early-Onset Sepsis Associated Acute Kidney Injury

摘要: 目的：分析新生儿早发型败血症(Early-Onset Sepsis, EOS)合并急性肾损伤(Actue Kidney Injury, AKI)患儿的临床资料，探索影响新生儿早发型败血症并发急性肾损伤(Early-Onset Sepsis Associated Acute Kidney Injury, ESA-AKI)预后的危险因素。方法：通过回顾分析2018年1月至2022年4月于我院新生儿科病房住院的符合ESA-AKI患儿的临床资料，研究期间共纳入90例患儿，根据出院时患儿的情况分为好转组(n = 66)和放弃/死亡组(n = 24)，比较两组临床资料，分析影响新生儿ESA-AKI预后的危险因素。结果：单因素分析发现，与好转组相比，放弃/死亡组患儿母孕期糖尿病比例(8.3%对31.8%，P = 0.024)、入院时血肌酐值(72.6对130.6，P = 0.024)和血尿素氮值低(4.68对6.71，P = 0.025)，女性比例高(62.5%对36.4%，P = 0.027)，合并感染性休克(58.3%对28.8%，P = 0.010)、重度AKI(33.3%对3.0%，P = 0.000)比例高，多巴胺暴露率高(91.7%对71.2%，P = 0.042)。二元logistic回归分析发现女性(OR = 3.59, 95%CI: 1.08~12.05, P = 0.038)和重度AKI (OR = 14.31, 95%CI: 2.30~89.14, P = 0.004)是新生儿ESA-AKI预后的独立危险因素。结论：女性和重度AKI显著增加ESA-AKI患儿不良预后风险。

Abstract: Objective: The clinical data of neonates with early-onset sepsis (EOS) associated with acute kidney injury (AKI) were analyzed in order to explore the risk factors affecting the prognosis of neonatal early-onset sepsis associated with acute kidney injury (ESA-AKI). Methods: The clinical data of 90 neonates who met the diagnostic criteria for ESA-AKI and had completed clinical data from January 2018 to April 2022 were reviewed. A total of 90 neonates were included during the study period, according to the treatment outcome, the neonates were divided into the improvement group (n = 66) and the abandonment/death group (n = 24), and the clinical characteristics of the two groups were compared to analyze the risk factors affecting the prognosis of neonatal AKI. Results: Univariate analysis revealed that compared with the improvement group, the abandonment/death group had a lower proportion of maternal diabetes mellitus (8.3% VS 31.8%, P = 0.024), lower serum creatinine (72.6 VS 130.6, P = 0.024) and serum urea nitrogen values (4.68 VS 6.71, P = 0.025) on admission, a higher proportion of females (62.5% VS 36.4%, P = 0.027), a higher incidence of combined septic shock and severe AKI (33.3% VS 3.0%, P = 0.000), and a higher rate of using dobutamine (91.7% VS 71.2%, P = 0.042). In multivariate logistic regression analysis, it was found that females (OR = 3.59, 95%CI: 1.08~12.05, P = 0.038) and severe AKI (OR = 14.31, 95%CI: 2.30~89.14, P = 0.004) are independent risk factors for the prognosis of neonatal ESA-AKI. Conclusion: Female and severe AKI significantly increased the risk of poor prognosis in children with ESA-AKI.