老年住院患者急性肾损伤后肾科医师会诊率及早期会诊影响因素分析

Nephrological consultation rate and influencing factors for early consultation in the elderly patients with acute kidney injury

摘要:

目的 了解非肾科病房老年人急性肾损伤(AKI)后的肾科医师会诊率,比较邀请肾科医师会诊和没有邀请会诊的2组老年AKI患者的临床特征,分析影响肾科医师早期会诊的因素。方法 回顾性分析2007年1月1日至2015年12月31日就诊于解放军总医院老年病房住院患者的病历资料639例。根据有无邀请肾科医师会诊分为2组:会诊组(n＝154)和未会诊组(n＝485),其中会诊组又依据会诊时间的早晚分为2个亚组:早期会诊组(n＝95)和延迟会诊组(n＝59)。早期会诊定义为AKI发生后48 h内邀请会诊,晚期会诊定义为AKI发生48 h后邀请会诊。采用SPSS 17.0软件进行统计分析。采用多因素logistic分析影响会诊及会诊时间的相关因素。结果 639例患者,中位年龄 87(84,91)岁。24.1%(154/639)的患者邀请了肾科医师会诊,中位会诊时间是AKI发生后2(1,4)d；其中61.7%(95/154)的患者为早期会诊,中位会诊时间是AKI发生后1(1,2)d。多因素logistic回归分析显示,邀请肾科医师会诊的患者伴有慢性阻塞性肺疾病(COPD)病史的比例较高(OR=1.685,95%CI 1.057～2.687,P=0.028)、AKI诊断时间早(OR=0.899,95%CI 0.821～0.985,P=0.022)、血肌酐(SCr)峰值水平(OR=1.005,95%CI 1.002～1.007,P<0.001)和血尿素氮(BUN)水平(OR=1.020,95%CI 1.001～1.039,P=0.036)均较未邀请肾科医师会诊的患者高。肾科医师会诊有38.3%(59/154)是滞后的(>48 h),中位会诊时间是AKI 发生后4(3,8)d。多因素logistic回归分析显示,AKI诊断时间较晚(OR=1.214,95%CI 1.041～1.416,P=0.013)、尿量不减少(OR=0.115,95%CI 0.014～0.953,P=0.045)和尿酸水平不高(OR=0.997,95%CI 0.994～0.999,P=0.014)是影响肾科医师早期会诊的独立危险因素。结论 AKI诊断时间不仅影响肾科医师会诊,也是导致会诊不及时的原因,早期诊断AKI有助于肾科医师的早期会诊。

Abstract:

Objective To investigate the rate of nephrological consultation (NC) in non-nephrological hospitalized elderly patients after acute kidney injury (AKI), and compare the clinical and laboratory characteristics between the patients consulted by nephrologists or not, and analyze the risk factors for early consultation. Methods A total of 639 elderly patients hospitalized in the geriatric department from January 2007 to 2015 were enrolled in this study, and their clinical data were collected and retrospectively analyzed. According to undergoing NC or not, these patients were divided into consultation group (n=154) and non-consultation group (n=485). The former group was further assigned into early consultation subgroup (n=95, undergoing NC within 48 h after AKI) and delayed consultation subgroup (n=59, undergoing NC after 48 h following AKI). SPSS statistics 17.0 was used for data processing. Multivariate logistic regression analysis was employed to identify the related factors for doing consultation and time of consultation. Results The 639 AKI patients were at a median age of 87(84,1) years, and 24.1%(154/639) of them underwent NC. The median time for NC was in 2(1,4)d after AKI. Indeed, most patients referred to nephrologists underwent early NC (61.7%, 95/154), with a median time for consultation of 1(1,2)d. Multivariate logistic regression analysis revealed that NC patients had significantly higher ratio of chronic obstructivepulmonary disease (COPD, OR=1.685,5%CI 1.057-2.687, P=0.028), earlier diagnosis of AKI (OR=0.899,5%CI:0.821-0.985, P=0.022), higher peak serum creatinine level (OR=1.005,5%CI 1.002-1.007, P<0.001),and higher blood urea nitrogen level (OR=1.020,5%CI 1.001-1.039, P=0.036) than the patients not undergoing NC. NC was delayed (>48 h) in 59 patients (38.3%, 59/154), with a median time of 4(3,8)d. Multivariate logistic regression analysis showed that later AKI diagnosis (OR=1.214, 95%CI 1.041-1.416, P=0.013), non-decreasing urine volume (OR=0.115,5%CI 0.014-0.953, P=0.045), and not higher uric acid level (OR=0.997,5%CI 0.994-0.999, P=0.014) were independent risk factors for early NC. Conclusion The time for AKI diagnosis not only affects NC, but also leads to delayed NC. Early AKI diagnosis is helpful to early NC.