蔡晓燕,张晓燕,张瑞芹.老年急性肾损伤患者不同体质量指数临床特点及对预后的影响[J].转化医学杂志,2021,10(5):310-314
老年急性肾损伤患者不同体质量指数临床特点及对预后的影响
Comparative study to assess the association between BMI level and short-term prognosis by using KDIGO criteria of acute kidney injury in elderly patients
  
DOI:
中文关键词:  急性肾损伤  体质量指数  老年人  预后  危险因素
英文关键词:Acute kidney injury  Body mass index  Elderly  Short-term mortality  Risk factors
基金项目:
作者单位
蔡晓燕 解放军总医院第二医学中心肾脏病科国家老年疾病临床医学研究中心 
张晓燕 解放军总医院第二医学中心肾脏病科国家老年疾病临床医学研究中心 
张瑞芹 解放军总医院第二医学中心肾脏病科国家老年疾病临床医学研究中心 
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中文摘要:
      目的 对高龄老年急性肾损伤 (acute kidney injury, AKI) 患者进行连续观察,分析不同体质量指数 (body mass index, BMI) 对AKI患者短期预后的影响。方法 选择2010年1月-2015年12月就诊于解放军总医院≥75岁的住院患者为研究对象。AKI诊断标准根据改善全球肾脏病预后组织 (KDIGO) 指南的Scr诊断标准。根据最佳cut-off值将BMI分为较高组 [BMI≥23.1(kg/m2)] 和较低组 [BMI<23.1(kg/m2)],根据AKI后90 d时患者的生存情况,将患者病历资料分为死亡组和存活组进行分析,多因素Cox回归分析BMI水平对AKI患者90 d生存的影响。结果 随访期间,纳入318例患者进行分析,其中男性308例,占96.9%,中位年龄87 (84~91)岁。与较低BMI组比较,较高BMI组高血压 (80.9%比71.2%, P=0.042) 病史比例较高,基础Scr (78.5比72.5 μmol/L, P=0.002)较高,基础eGFR (76.4比78.2 mL/min/1.73 m2,P=0.007)较低,患者发生脓毒症的比例较低(27.8% 比 46.8%,P<0.001),接受手术治疗比例较高(8.6%比0,P<0.001);与较低BMI组比较,较高BMI组AKI确诊时血清前白蛋白 (212比182 g/L,P=0.038)、血清白蛋白 (36.1±5.6比34.5±5.4 g/L,P=0.009)和血红蛋白 (116±23比108±22 g/L,P=0.003)水平较高,AKI 2期与3期 (17.3%比32.1%,17.9% 比20.5%;P=0.003)比例较低,90 d病死率(16.7%比32.1%,P=0.001)较低,差异有统计学意义。采用Kaplan-Meier生存曲线比较显示,BMI ≥23.1 (kg/m2) 患者的90 d生存状况要显著好于BMI <23.1 (kg/m2) 患者。多因素Cox分析显示低BMI显著增加了患者90 d死亡。结论 重视老年住院患者中低BMI的患者,低BMI水平老年AKI患者90 d病死率更高。老年人适宜的BMI水平可能更高
英文摘要:
      Objective To compare the clinical characteristics and evaluate the association between body mass index (BMI) level and 90-day mortality of acute kidney injury (AKI) in elderly patients.Methods We retrospectively enrolled elderly patients (≥75 years) from the Chinese PLA General Hospital between January 2010 and December 2015. AKI was defined according to the KDIGO criteria. All study participants were divided into two group based on BMI (with cutoff at 23.1 kg/m2). They were also divided into survivor and non-survivor groups by their outcomes within 90 days after AKI. Prognostic survival factors were identified using the Cox proportional hazards regression model.Results In total, 318 patients were included in the final analysis. The median age of the cohort was 87 (84~91) years, the majority (308, 96.9%) was were male. The hihger BMI group (≥23.1 kg/m2) had higher ratio of hypertension, higher baseline serum creatinine (Scr), lower basal eGFR than the lower BMI group. Patients with hihger BMI group were more frequently treated surgically and suffered less often from sepsis. They also more frequently had significantly higher prealbumin levels, higher albuminemia levels, and higher hemoglobin levels at the time of AKI diagnosis compared with patients with lower group. Patients with higher group presented lower mortality rates and less frequently exhibited stage 2 and 3 AKI. Similarly, patients with BMI≥23.1(kg/m2) had better survival than patients with lower level. The multivariate Cox analysis results showed that low BMI was an independent risk factor for the 90-day mortality of elderly patients.Conclusion Identifiation of these factors might lead to more intensive monitoring and early prevention and could improve outcomes for very elderly patients with AKI. The suitable BMI for elderly people might be higher.
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