血压反应指数对老年重症肺炎休克患者急性肾损伤的影响研究

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【中图分类号】R563.1 【文献标识码】A DOI：10.12114/j.issn.1007-9572.2025.0159

【Abstract】BackgroundTherisk factors leading toacute kidney injury（AKI） inelderlypatients with severe pneumoniahavenotyetbeenfullyclarified.ObjectiveToinvestigate theasociationbetweentheblood pressureresponse index （BPRI）andtheincidenceofAKIinelderlypatientswithseverepneumonia-inducedshock.MethodsAretrospectivecohortstudy wasconductedtocollectclinicaldatafrompatientswithseverepneumonia-inducedshockadmitedtotheSecondPeople'sHospital of Changzhoubetween2O16and2O24.Theclinicaldataof patientsweresystematicallyextractedfromthehospital'selectronic medicalrecord system.BPRI wascalculatedas meanarterial pressuredividedbythevasoactive-inotropicscore.Documentthe incidenceofAKIfollowinghospitalizationandthe3O-daysurvivalrate.MultivariateLogisticregressionanalysis waspefoed to evaluate theriskvalueof BPRIforAKIdevelopment.Receiveroperating characteristic （ROC）curves wereconstructed toassess thepredictiveaccuracyofBPRIforAKI，with theareaunderthecurve（AUC）indicating thestrengthof prediction.Kaplan-Meier survivalcurveswereusedtoanalze3O-daymortalityamongpatientsstraifedbyAKIrisk，withdiferences testedusingtheLog rank test. ResultsA total of 237 patients were included in the study，of whom 96 （40.5 % ） developed AKI. Multivariate Logistic regresionanalysisrevealedthatelevatedBPRIwasaprotectivefactoragainst AKIdevelopment （OR=0.751，95%CI=0.6780831， P<0.001 ）， increased lactate （OR=1.239，95%CI=1.039-1.477， P =0.017） and elevated SOFA scores （OR=1.930， 95%CI=1.497- 2.488， P<0.001 ）were identifiedas risk factors for AKI development.ROC curveanalysis demonstrated thatthe AUCof BPRI for predictingAKIinpatients withsevere pneumonia-inducedshock was0.809（95%CI=0.752-0.865），withacutoffvalueof10063. Patients were stratified into high-risk （ BPRI⩾10.063 ， n =79）and low-risk （BPRI<10.063， n =158） groups for AKI development basedontheBPRIcutoffvalue.Kaplan-Meieranalysisdemonstratedsignificantlylower3O-daycumulativesurvivalrates inthe high-risk AKI group compared to the low-risk group （ χ2=35.310 P<0.001 ）. Conclusion Elevated BPRI serves as a protective factorgainstAKIdevelopment inpatientswithseverepneumonia-inducedshockandexhibitsexcellentpredictiveperformancfor AKI occurrence.

【Key words】 Severe pneumonia; Blood pressure response index; Shock; Acute kidney injury; Root cause analysis

社区获得性肺炎仍然是全球主要的感染性疾病，老年重症肺炎患者的死亡率仍居高不下，特别是合并休克的患者[1-2]。（剩余11370字）