老年心肾综合征患者的临床特征和预后分析

Clinical characteristics and prognosis of cardiorenal syndrome in the elderly

摘要:

目的 回顾性分析住院老年心肾综合征（CRS）患者的临床特征和住院死亡危险因素。方法 从解放军总医院信息系统检索到的2015年1月1日至2015年6月30日期间从普通病区出院的所有年龄≥65岁、临床诊断符合CRS定义的患者。采用回顾性分析方法，分别登记患者年龄、性别、就诊病因、伴发疾病、住院时间及转归等，从住院病历中和实验室信息系统提取入院时的生命体征以及入院时血常规、生化检查结果、治疗情况等。结果 197例患者符合CRS诊断。年龄（78.91±7.94）岁，中位住院时间13（7，25）d。其中Ⅰ型37例，占18.78%；Ⅱ型59例，占29.95%；Ⅲ型15例，占7.61%；Ⅳ型26例，占13.20%；Ⅴ型60例，占30.46%。利尿剂是CRS最常用的治疗药物（78.7%），55例患者（27.92%）接受了肾脏替代治疗，Ⅲ型和Ⅳ型CRS患者接受肾脏替代治疗最多。197例老年CRS患者住院死亡75例，占38.10%。logistic回归分析显示年龄、呼吸频率、白细胞、血清白蛋白和肾脏替代治疗是住院死亡的独立相关因素。结论 老年住院患者中Ⅰ型和Ⅴ型CRS所占比例最高，Ⅰ型、Ⅲ型和Ⅴ型CRS的死亡率高。年龄、血白细胞增加、呼吸频率增快和肾脏替代治疗是预测死亡的独立预警因素。

Abstract:

Objective To retrospectively analyze the clinical characteristics and risk factors for in-hospital death of the elderly patients with cardiorenal syndrome(CRS). Methods All over-65-year-old patients with eligible CRS according to Acute Dialysis Quality Initiative recommendations who discharged from general wards during January 2015 and June 2015 were identified from information system of our hospital. A retrospective study was performed on their medical records and clinical data, including age, sex, doctor visit causes, complicated diseases, hospitalization time and prognosis, vital signs at admission, admission blood routine and biochemical examination results, and treatment conditions, etc. Results There were 197 cases who were diagnosed with CRS. They were at an age of (78.91±7.94) years, and with a median hospital stay of 13(7, 25)d. There were 37 cases (18.78%) of CRS type Ⅰ, 59(29.95%) of type Ⅱ, 15(7.61%) of type Ⅲ, 26(13.20%) of type Ⅳ and 60(30.46%) of type Ⅴ. Diuretics were the most frequently prescribed agents (78.7%). Fifty-five patients underwent renal replacement therapy, and most of them were from the CRS type Ⅲ and Ⅳ groups. In-hospital death occurred in 38.10%(75 cases) of the patients. Logistic regression analysis showed that age, respiratory rate, white blood cell count (WBC), serum albumin, and renal replacement therapy were independent related factors for in-hospital death. Conclusion In the elderly with CRS, type Ⅰ and Ⅴ are more common, and type Ⅰ, Ⅲ and Ⅴ are of higher mortality. Age, higher WBC, faster respiratory rate and renal replacement therapy are independent predictive factors for death.