Risk factors and predictive value of early mortality in critically ill patients with septic acute kidney injury requiring continuous renal replacement therapy

doi:10.3877/cma.j.issn.2096-1537.2025.02.016

Abstract

Abstract:

Objective

To identify risk factors associated with 48-hour mortality following continuous renal replacement therapy （CRRT） initiation in patients with septic associated acute kidney injury（SAKI），and evaluate their predictive value for early mortality.

Methods

A retrospective cohort study of 258 SAKI patients who received CRRT in the Intensive Care Medicine Department of Beijing Friendship Hospital，Capital Medical University，between January 2016 and December 2021 was conducted.Patients were divided into survival group （203 cases） and non-survival group （55 cases） based on 48-hour mortality after CRRT initiation.Logistic regression was used to assess the risk factors for early mortality，and develop a composite predictor.Receiver operating characteristic （ROC） curve analysis was employed to assess the predictive performance of the combined prediction factor for early mortality.

Results

The 48-hour mortality rate was 21.3%.Multivariate logistic regression analysis revealed three independent risk factors for early death：lower creatinine levels ［OR=1.50 （per 100 μmol/L decrease），95% CI：1.15-1.95］，decreased oxygenation index［OR=1.05 （per 10 mmHg decrease），95% CI：1.02-1.09］，and elevated lactate levels ［OR=1.20 （per 1 mmol/L increase），95% CI：1.10-1.30］.The composite predictor showed an AUC of 0.804.

Conclusions

The low levels of creatinine and oxygenation index，as well as high lactate levels in critically ill SAKI patients receiving CRRT，significantly influence the early mortality.The derived composite predictor demonstrates clinically meaningful performance for early mortality risk stratification.

Key words: Sepsis, Acute kidney injury, Continuous renal replacement therapy, Early mortality

Jin Lin, Chenlong Zhao, Zhilin Yue, Meili Duan. Risk factors and predictive value of early mortality in critically ill patients with septic acute kidney injury requiring continuous renal replacement therapy[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2025, 11(02): 186-192.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2025.02.016

https://icu.cma-cmc.com.cn/EN/Y2025/V11/I02/186

Figures/Tables 5

References 19

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指标	总体（258 例）	存活组（203 例）	死亡组（55 例）	统计值	P 值
年龄（岁， x̄ ± s ）	65.4 ± 18.2	65.7 ± 18.6	64.2 ± 14.6	t=0.544	0.587
男性 [例（%）]	164 (63.6)	133 (65.5)	31 (56.4)	χ²=1.566	0.210
BMI（kg/m²， x̄ ± s ）	23.9 ± 4.5	24.0 ± 4.3	23.6 ± 5.1	t=0.613	0.541
CCI [ M(Q₁,Q₃) ]	2 (1, 3)	2 (1, 3)	1 (1, 2)	Z=0.388	0.698
患者来源 [例（%）]
急诊入院	74 (28.7)	65 (32.0)	9 (16.4)	χ²=5.186	0.023
内科病房	94 (36.4)	68 (33.5)	26 (47.3)	χ²=3.546	0.060
外科病房	90 (34.9)	70 (34.5)	20 (36.4)	χ²=0.067	0.795
患者入 ICU 原因 [例（%）]
呼吸系统疾病	80 (31.0)	69 (34.0)	11 (20.0)	χ²=3.959	0.047
心血管系统疾病	26 (10.1)	21 (10.3)	5 (9.1)	χ²=0.075	0.784
消化系统疾病	80 (31.0)	58 (28.6)	22 (40.0)	χ²=2.642	0.104
肾脏系统疾病	23 (8.9)	21 (10.3)	2 (3.6)	χ²=2.398	0.121
血液系统疾病	24 (9.3)	16 (7.9)	8 (14.5)	χ²=2.278	0.131
其他疾病	25 (9.7)	18 (8.9)	7 (12.7)	χ²=0.737	0.391
感染部位 [例（%）]
呼吸系统	147 (57.0)	115 (56.7)	32 (58.2)	χ²=0.041	0.839
腹腔系统	59 (22.9)	48 (23.6)	11 (20.0)	χ²=0.326	0.568
血行感染	14 (5.4)	8 (3.9)	6 (10.9)	χ²=4.095	0.043
泌尿系统	14 (5.4)	12 (5.9)	2 (3.6)	χ²=0.436	0.509
皮肤软组织	9 (3.5)	9 (4.4)	0	χ²=2.527	0.112
其他部位	15 (5.8)	11 (5.4)	4 (7.3)	χ²=0.272	0.602
SOFA 评分（分， x̄ ± s ）	11.2 ± 3.7	10.9 ± 3.6	12.4 ± 4.0	χ²=2.706	0.007
有创机械通气 [例（%）]	178 (69.0)	137 (67.5)	41 (74.5)	χ²=1.193	0.551
使用血管活性药 [例（%）]	173 (68.1)	126 (63.3)	47 (85.5)	χ²=9.723	0.002
CRRT 开始前 24 h 尿量 [ml, M(Q₁,Q₃) ]	480 (246, 849)	460 (240, 830)	645 (370, 1058)	Z=1.875	0.061
CRRT 开始前累积液体平衡（ml， x̄ ± s ）	4271 ± 3128	4132 ± 3113	4793 ± 3161	t=1.369	0.172
白细胞 [ ×10⁹/L, M(Q₁,Q₃) ]	12.1 (7.1, 19.3)	12.2 (7.1, 20.2)	11.4 (6.2, 15.2)	Z=1.561	0.118
血红蛋白（g/L， x̄ ± s ）	91.1 ± 24.2	88.3 ± 22.1	91.8 ± 24.8	t=0.971	0.333
血小板 [ ×10⁹/L, M(Q₁,Q₃) ]	90.5 (48.5, 159.6)	94.0 (52.0, 164.0)	80.0 (29.0, 153.0)	Z=1.442	0.149
血肌酐 [μmol/L, M(Q₁,Q₃) ]	244.3 (148.8, 384.5)	265.4 (169.0, 431.2)	167.6 (120.1, 257.3)	Z=4.082	<0.001
白蛋白（g/L， x̄ ± s ）	25.81 ± 4.55	26.07 ± 4.43	24.9 ± 4.91	t=1.678	0.277
血钾（mmol/L， x̄ ± s ）	4.6 ± 0.8	4.6 ± 0.7	4.7 ± 0.8	t=0.795	0.427
碳酸氢根（mmol/L， x̄ ± s ）	21.6 ± 6.9	21.5 ± 6.2	21.8 ± 9.0	t=0.278	0.781
氧合指数 [mmHg, M(Q₁,Q₃) ]	179 (121, 267)	197 (127, 277)	140 (94, 202)	Z=3.145	0.002
血乳酸 [mmol/L, M(Q₁,Q₃) ]	2.4 (1.4, 4.6)	1.7 (1.3, 3.5)	2.4 (1.5, 5.1)	Z=5.403	<0.001
降钙素原[pg/ml,M(Q₁,Q₃)]	5.83(1.61,18.04)	5.70(1.47,18.16)	6.40(1.77,18.02)	Z=0.387	0.699
氨基末端脑钠肽前体[pg/ml,M(Q₁,Q₃)]	9771(2482,28978)	8870(2056,30000)	11030(3615,21772)	Z=0.027	0.979

指标	总体（258 例）	存活组（203 例）	死亡组（55 例）	统计值	P 值
年龄（岁， x̄ ± s ）	65.4 ± 18.2	65.7 ± 18.6	64.2 ± 14.6	t=0.544	0.587
男性 [例（%）]	164 (63.6)	133 (65.5)	31 (56.4)	χ²=1.566	0.210
BMI（kg/m²， x̄ ± s ）	23.9 ± 4.5	24.0 ± 4.3	23.6 ± 5.1	t=0.613	0.541
CCI [ M(Q₁,Q₃) ]	2 (1, 3)	2 (1, 3)	1 (1, 2)	Z=0.388	0.698
患者来源 [例（%）]
急诊入院	74 (28.7)	65 (32.0)	9 (16.4)	χ²=5.186	0.023
内科病房	94 (36.4)	68 (33.5)	26 (47.3)	χ²=3.546	0.060
外科病房	90 (34.9)	70 (34.5)	20 (36.4)	χ²=0.067	0.795
患者入 ICU 原因 [例（%）]
呼吸系统疾病	80 (31.0)	69 (34.0)	11 (20.0)	χ²=3.959	0.047
心血管系统疾病	26 (10.1)	21 (10.3)	5 (9.1)	χ²=0.075	0.784
消化系统疾病	80 (31.0)	58 (28.6)	22 (40.0)	χ²=2.642	0.104
肾脏系统疾病	23 (8.9)	21 (10.3)	2 (3.6)	χ²=2.398	0.121
血液系统疾病	24 (9.3)	16 (7.9)	8 (14.5)	χ²=2.278	0.131
其他疾病	25 (9.7)	18 (8.9)	7 (12.7)	χ²=0.737	0.391
感染部位 [例（%）]
呼吸系统	147 (57.0)	115 (56.7)	32 (58.2)	χ²=0.041	0.839
腹腔系统	59 (22.9)	48 (23.6)	11 (20.0)	χ²=0.326	0.568
血行感染	14 (5.4)	8 (3.9)	6 (10.9)	χ²=4.095	0.043
泌尿系统	14 (5.4)	12 (5.9)	2 (3.6)	χ²=0.436	0.509
皮肤软组织	9 (3.5)	9 (4.4)	0	χ²=2.527	0.112
其他部位	15 (5.8)	11 (5.4)	4 (7.3)	χ²=0.272	0.602
SOFA 评分（分， x̄ ± s ）	11.2 ± 3.7	10.9 ± 3.6	12.4 ± 4.0	χ²=2.706	0.007
有创机械通气 [例（%）]	178 (69.0)	137 (67.5)	41 (74.5)	χ²=1.193	0.551
使用血管活性药 [例（%）]	173 (68.1)	126 (63.3)	47 (85.5)	χ²=9.723	0.002
CRRT 开始前 24 h 尿量 [ml, M(Q₁,Q₃) ]	480 (246, 849)	460 (240, 830)	645 (370, 1058)	Z=1.875	0.061
CRRT 开始前累积液体平衡（ml， x̄ ± s ）	4271 ± 3128	4132 ± 3113	4793 ± 3161	t=1.369	0.172
白细胞 [ ×10⁹/L, M(Q₁,Q₃) ]	12.1 (7.1, 19.3)	12.2 (7.1, 20.2)	11.4 (6.2, 15.2)	Z=1.561	0.118
血红蛋白（g/L， x̄ ± s ）	91.1 ± 24.2	88.3 ± 22.1	91.8 ± 24.8	t=0.971	0.333
血小板 [ ×10⁹/L, M(Q₁,Q₃) ]	90.5 (48.5, 159.6)	94.0 (52.0, 164.0)	80.0 (29.0, 153.0)	Z=1.442	0.149
血肌酐 [μmol/L, M(Q₁,Q₃) ]	244.3 (148.8, 384.5)	265.4 (169.0, 431.2)	167.6 (120.1, 257.3)	Z=4.082	<0.001
白蛋白（g/L， x̄ ± s ）	25.81 ± 4.55	26.07 ± 4.43	24.9 ± 4.91	t=1.678	0.277
血钾（mmol/L， x̄ ± s ）	4.6 ± 0.8	4.6 ± 0.7	4.7 ± 0.8	t=0.795	0.427
碳酸氢根（mmol/L， x̄ ± s ）	21.6 ± 6.9	21.5 ± 6.2	21.8 ± 9.0	t=0.278	0.781
氧合指数 [mmHg, M(Q₁,Q₃) ]	179 (121, 267)	197 (127, 277)	140 (94, 202)	Z=3.145	0.002
血乳酸 [mmol/L, M(Q₁,Q₃) ]	2.4 (1.4, 4.6)	1.7 (1.3, 3.5)	2.4 (1.5, 5.1)	Z=5.403	<0.001
降钙素原[pg/ml,M(Q₁,Q₃)]	5.83(1.61,18.04)	5.70(1.47,18.16)	6.40(1.77,18.02)	Z=0.387	0.699
氨基末端脑钠肽前体[pg/ml,M(Q₁,Q₃)]	9771(2482,28978)	8870(2056,30000)	11030(3615,21772)	Z=0.027	0.979

因素	单位	单因素模型			多因素模型
		OR 值	95%CI	P 值	OR 值	95%CI	P 值
急诊入院	是	0.42	0.19~0.90	0.026	-	-	-
呼吸系统疾病	是	0.49	0.24~0.99	0.050	-	-	-
SOFA 评分	每升高 1 分	1.12	1.03~1.22	0.008	-	-	-
血管活性药使用	是	3.38	1.51~7.54	0.003	-	-	-
白细胞	每升高 10⁹/L	0.97	0.94~0.99	0.030	-	-	-
肌酐	每降低 100 mol/L	1.65	1.28~2.12	<0.001	1.50	1.15~1.95	0.003
氧合指数	每降低 10 mmHg	1.07	1.03~1.11	0.001	1.05	1.02~1.09	0.005
乳酸	每升高 1 mmo/L	1.22	1.13~1.31	<0.001	1.20	1.10~1.30	<0.001

因素	单位	单因素模型			多因素模型
		OR 值	95%CI	P 值	OR 值	95%CI	P 值
急诊入院	是	0.42	0.19~0.90	0.026	-	-	-
呼吸系统疾病	是	0.49	0.24~0.99	0.050	-	-	-
SOFA 评分	每升高 1 分	1.12	1.03~1.22	0.008	-	-	-
血管活性药使用	是	3.38	1.51~7.54	0.003	-	-	-
白细胞	每升高 10⁹/L	0.97	0.94~0.99	0.030	-	-	-
肌酐	每降低 100 mol/L	1.65	1.28~2.12	<0.001	1.50	1.15~1.95	0.003
氧合指数	每降低 10 mmHg	1.07	1.03~1.11	0.001	1.05	1.02~1.09	0.005
乳酸	每升高 1 mmo/L	1.22	1.13~1.31	<0.001	1.20	1.10~1.30	<0.001

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