分析老年危重症患者并发急性肾损伤（AKI）的危险因素及连续肾脏替代（CRRT）介入治疗的效果。

回顾性选择2019年1月至2024年1月杭州市第一人民医院接诊的110例老年危重症患者作为研究对象，其中男性85例，女性25例；年龄78~95岁，平均（88.89±4.18）岁。根据AKI发生情况分为AKI组（53例）和非AKI组（57例），收集两组患者临床资料[性别、年龄、体质量指数（BMI）、合并基础疾病、心肺复苏、入院时pH值、入院时序贯器官衰竭（SOFA）评分、急性生理和慢性健康状况Ⅱ（APACHEⅡ）评分、入院时血糖、入院时白蛋白、入院时血红蛋白（HGB）。及甘露醇、非甾体类抗炎药、氨基糖苷类、去甲万古霉素、替考拉宁、呋塞米、羟乙基淀粉使用情况]，采用多因素Logistic回归分析老年危重症并发AKI的危险因素，通过受试者操作特征曲线（ROC）分析各独立危险因素对AKI的预测价值。

两组患者SOFA评分、APACHEⅡ评分、入院时血糖、入院时白蛋白、入院时HGB比较差异有统计学意义（P<0.05）。两组性别、年龄、BMI、合并基础疾病、心肺复苏、入院时pH值、入院时HGB、甘露醇、非甾体类抗炎药、氨基糖苷类、去甲万古霉素、替考拉宁、呋塞米、羟乙基淀粉使用情况比较差异无统计学意义（P>0.05）。多因素非条件Logistic分析结果显示，SOFA评分、APACHEⅡ评分、入院时血糖、入院时白蛋白、入院时HGB、出现休克均是老年危重症并发AKI的独立危险因素（P<0.05）。ROC分析显示，上述独立危险因素联合预测AKI的曲线下面积为0.819（95% CI：0.741~0.914）。53例并发AKI患者经CRRT介入治疗后，显效患者17例，有效22例，无效14例。

老年危重症患者并发AKI的危险因素主要是SOFA评分、APACHEⅡ评分、入院时血糖、入院时白蛋白、入院时HGB。CRRT介入治疗有一定的临床效果。

To analyze the risk factors of acute kidney injury (AKI) in critically-ill elderly patients and the effectiveness of continuous renal replacement therapy (CRRT) intervention.

A total of 110 elderly critically-ill patients admitted to the First People's Hospital of Hangzhou from January 2019 to January 2024 were selected as the research subjects, including 85 males and 25 females. The age ranged from 78 to 95 years, with an average of (88.89±4.18) years. According to the occurrence of AKI, they were divided into 53 cases in AKI group and 57 cases in non-AKI group. Clinical data of the two groups of patients were collected, including gender, age, body mass index (BMI), underlying diseases, cardiopulmonary resuscitation, pH value at admission, sequential organ failure assessment (SOFA) score at admission, acute physiology and chronic health evaluation II (APACHE II) score, blood glucose at admission, albumin at admission, hemoglobin (HGB) at admission, and mannitol. The use of non-steroidal anti-inflammatory drugs, aminoglycosides, norvancomycin, teicoplanin, furosemide, and hydroxyethyl starch was analyzed using a multivariate Logistic regression model to investigate the risk factors of AKI in elderly critically-ill patients and the clinical effect of CRRT interventional therapy. The predictive value of each independent risk factor for AKI was analyzed through the receiver operating characteristic curve (ROC).

There was a statistically significant difference (P<0.05) in SOFA score, APACHE II score, admission blood glucose, admission albumin, and admission HGB between the two groups of patients. There was no statistically significant difference of gender, age and BMI between the two groups, in the use of combined underlying diseases, cardiopulmonary resuscitation, pH value at admission, HGB at admission, mannitol, nonsteroidal anti-inflammatory drugs, aminoglycosides, vancomycin, teicoplanin, furosemide, and hydroxyethyl starch (P>0.05). The results of multivariate unconditional logistic analysis showed that SOFA score, APACHE II score, admission blood glucose, admission albumin, admission HGB, and the occurrence of shock were all independent risk factors for AKI in elderly critically-ill patients (P<0.05). ROC analysis showed that the area under the curve of the combined prediction of these independent risk factors for AKI was 0.819 (95% CI: 0.741-0.914); After CRRT intervention treatment in 53 patients with concurrent AKI, 17 patients showed significant improvement, 22 were effective, and 14 were ineffective.

The main factors contributing to AKI in elderly critically-ill patients are SOFA score, APACHE II score, blood glucose at admission, albumin at admission, and HGB at admission. CRRT intervention therapy has a certain clinical effect.