不同液体负荷状态对持续肾替代治疗脓毒症相关急性肾损伤患儿预后的影响

Effect of fluid load on the prognosis of children with sepsis-associated acute kidney injury undergoing continuous renal replacement therapy

摘要:

目的 评估不同液体负荷（fluid load，FL）对使用持续肾替代治疗（continuous renal replacement therapy，CRRT）的脓毒症相关急性肾损伤（acute kidney injury，AKI）患儿预后的影响。 方法 回顾性选取2018年8月至2021年3月因脓毒症相关AKI行CRRT的患儿121例为研究对象，根据患儿从入院或病情变化开始至行CRRT前的不同FL分为低液体负荷组（n=35，FL<5%）、高液体负荷组（n=35，5%≤FL<10%）和液体超负荷组（n=51，FL≥10%）。收集各组患儿CRRT治疗前的基线资料和临床生化资料进行比较分析。采用Kaplan-Meier生存曲线分析各组间的28 d生存情况。采用多因素logistic回归分析影响不同FL状态患儿预后的危险因素。 结果 生存分析结果提示液体超负荷组患儿28 d病死率高于低液体负荷组和高液体负荷组（P<0.05）；多因素logistic回归分析结果提示正超液体量增加为导致液体超负荷组患儿28 d病死率增高的危险因素，而CRRT开始时间提前为其保护因素（P<0.05）。 结论 CRRT开始前液体超负荷会增加脓毒症相关AKI患儿的病死率，对该类患儿应尽早行CRRT治疗。

Abstract:

Objective To evaluate the effect of fluid load on the prognosis of children with sepsis-associated acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT). Methods A total of 121 children who underwent CRRT for sepsis-associated AKI from August 2018 to March 2021 were enrolled in the retrospective study. According to the fluid load from admission or disease progression to CRRT, they were divided into three groups: low fluid load (fluid load: <5%; n=35), high fluid load (fluid load: 5% - <10%; n=35), and fluid overload (fluid load: ≥10%; n=51). Baseline data and clinical biochemical data before CRRT were collected for comparison and analysis. The Kaplan-Meier survival curve analysis was used for comparison of 28-day survival between groups. The multivariate logistic regression model was used to identify the influencing factors for the prognosis of the children. Results The survival analysis showed that the fluid overload group had a significantly higher 28-day mortality rate than the low fluid load and high fluid load groups (P<0.05). The multivariate logistic regression analysis showed that an increase in fluid overload volume was a risk factor for increased 28-day mortality in the fluid overload group, while earlier initiation of CRRT was a protective factor (P<0.05). Conclusions Fluid overload before CRRT may increase the mortality in children with sepsis-associated AKI, and CRRT should be performed for these children as early as possible.