Yếu tố nguy cơ tổn thương thận cấp ở bệnh nhân điều trị tại Khoa hồi sức tích cực Bệnh viện Nhân Dân 115

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Tác giả: Lê Hồng Phát Nguyễn, Đình Thắng Vũ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2023

Mô tả vật lý: tr.133

Bộ sưu tập: Metadata

ID: 339297

Thêm vào giỏ Liên kết toàn văn

- Đặt vấn đề: Tổn thương thận cấp là rối loạn chức năng cơ quan thường gặp nhất ở các khoa hồi sức, làm tăng tỷ lệ tử vong và gây ảnh hưởng xấu tới kết cục của bệnh nhân. Việc xác định các yếu tố nguy cơ tổn thương thận cấp là cần thiết vì phương pháp điều trị tối ưu nhất hiện nay vẫn là phòng ngừa và phát hiện sớm tổn thương thận cấp trên các bệnh nhân có nguy cơ cao trước khi các biến chứng xuất hiện. Vì vậy, chúng tôi thực hiện nghiên cứu với mục tiêu xác định các yếu tố nguy cơ tổn thương thận cấp ở bệnh nhân điều trị tại khoa hồi sức.- Mục tiêu: Xác định các yếu tố nguy cơ tổn thương thận cấp ở bệnh nhân điều trị tại khoa hồi sức.- Phương pháp nghiên cứu: Nghiên cứu đoàn hệ tiến cứu trên 150 bệnh nhân nhập khoa hồi sức trong thời gian từ tháng 01/2020 tới tháng 06/2020.- Kết quả: Tỷ lệ tổn thương thận cấp tại khoa hồi sức là 53,33%, trong đó tổn thương thận cấp giai đoạn 3 chiếm tỷ lệ cao nhất. Các yếu tố nguy cơ độc lập của tổn thương thận cấp bao gồm: nhiễm khuẩn huyết (OR = 3,37, KTC 95% 1,03 - 11,01
p = 0,039), tiền căn bệnh thận mạn (OR = 3,4, KTC 95% 1,01 - 11,48, p = 0,042), điểm APACHE II (OR = 1,28, KTC 95% 1,11 - 1,47, p <
0,001) và sử dụng thuốc vận mạch (OR = 3,59, KTC 95% 1,02 - 12,69, p = 0,044). Điểm APACHE II ≥ 18 có giá trị tiên đoán tốt tổn thương thận cấp xuất hiện tại khoa hồi sức với độ nhạy là 84% và độ đặc hiệu là 67%.- Kết luận: Nhiễm khuẩn huyết, tiền căn bệnh thận mạn, điểm APACHE II cao và sử dụng thuốc vận mạch là những yếu tố nguy cơ tổn thương thận cấp tại khoa hồi sức. Điểm APACHE II dự đoán tốt tổn thương thận cấp tại khoa hồi sức.Abstract- Background: Acute kidney injury (AKI) is the most frequent organ dysfunction in patients admitted to the intensive care units (ICU), and is associated with higher mortality and adverse outcomes. It is crucial to define which patients are at risk of developing AKI because no specific treatment is available to reverse AKI and early recognition of such patients is likely to result in better outcomes. Thus, we conducted a study to determine risk factors of AKI in patients admitted to the ICU.- Objects: Determine risk factors of AKI in patients admitted to the ICU.- Methods: Prospective cohort study, on 150 patients admitted to the ICU, 115 people’s Hospital, from January 2020 to June 2020.- Results: AKI occurred in 53.33% ICU patients, withKDIGO stage 3 AKI accounted for the highest proportion. Independent risk factors for AKI were: sepsis (OR = 3.37, 95% CI 1.03 - 11.01, p = 0.039), prior chronic kidney disease (OR = 3.4, 95% CI 1.01 - 11.48, p = 0.042), increment in APACHE II score (OR = 1.28, 95% CI 1.11 - 1.47, p <
0.001) and vasopressors (OR = 3.59, 95% CI 1.02 - 12.69, p = 0.044). The APACHE II score of ≥ 18 significantly predicted AKI developed in the ICU with sensitivity of 84% and specificity of 67%.- Conclusion: Sepsis, history of CKD, APACHE II score and vasopressors are independent risk factors of AKI in patients admitted to the ICU. The APACHE II score of 18 or higher can predict the development of AKI after ICU admission. DOI: 10.59715/pntjmp.2.2.17

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