关键词: 急性肾损伤, RIFLE分级, 老年肺炎, 社区获得性肺炎, 预后

Abstract: Objective　To explore whether RIFLE grades in evaluation of cute kidney injury (AKI) can predict the prognosis in elderly patients with community-acquired pneumonia (CAP). Methods　Four hundred and eight no less than 65-year-old patients with definite diagnosis as CAP treated at Fuzhou Pulmonary Hospital from January 2017 to December 2021 were selected, including 313 males and 95 females. According to the RIFLE grades, there were 281 cases in the no-AKI group and 127 cases in the AKI group. The AKI group was further stratified into a risk group (61 cases), an injury group (47 cases), and a failure group (19 cases). The influences of demographic characteristics and severities on prognosis in the four groups were compared. The measurement data of normal distribution were compare between the groups by ANOV, and the measurement data not of normal distribution by rank sum test. The enumeration data were compared by chi square test. The two-way ordinal categorical data were done by Spearman correlation test. Results　In this study, 127 patients developed AKI. The incidence of AKI was 31.1%. The majority of the patients in every group was male. There were no statistical differences in gender and smoke history between the 4 groups. The AKI group was (74.8±4.8) years old, the risk group (73.9±4.1), the injury group (74.1±4.1), and the failure group (79.8±5.4), indicating that AKI grades had a positive correlation with age (r=0.359). There were no statistical differences in the ratios of coronary heart disease, chronic obstructive pulmonary disease, and cerebrovascular disease between the 4 groups, but were in the ratios of hypertension [the no-AKI group 9.25% (26/281), the risk group 19.7% (12/61), the injury group 25.5% (12/47), and the failure 31.6% group (6/19)] and diabetes [the no-AKI group 15% (42/281), the risk group 22.9% (14/61), the injury group 27.6% (13/47), and the failure group 42.1% (8/19)] (χ²=17.216, P=0.001; χ²=12.560, P=0.006). The ratios of developing AKI between the low-risk and high-risk groups calculated by PSI and CURB-65 scores were 48.0% (61/127) vs. 52.0% (66/127) and 29.9% (38/127) vs 70.1% (89/127), respectively. With the rising grade of RIFLE, the portions of the patients administrated with machinal ventilation, vasoactive agents, and continuous renal replacement therapy also went up. The hospital stays in the no-AKI group, the risk group, the injury group, and the failure group were (12.2±2.4) days, (17.1±2.4) days, (19.8±3.0) days, and (29.8±4.7) days, and the mortalities 0.4% (1/281), 1.6% (1/61), 6.4% (3/47), and 47.4% (9/19), respectively, with statistical differences between the 4 groups. Correlation analysis showed that AKI grade was positively correlated with hospital stay (r=0.747) and mortality (r=0.992). Conclusions　The incidence of AKI is high in elderly patients with CAP, and has a positive correlation with age. Severe pneumonia complications with hypertension and diabetes cline to develop AKI, resulting in prolonged hospitalization and increased mortality.

Key words: Acute kidney injury, RIFLE grades, Elderly pneumonia, Community-acquired pneumonia, Prognosis