대퇴골 골절 환자에서 발생한 급성신손상의 위험인자와 임상경과
Risk Factors and the Clinical Course of Acute Kidney Injury in Patients with a Femoral Fracture
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목적: 대퇴골 골절은 주로 고령에서 발생하며 급성신손상등 내과적 합병증의 빈도가 높으나 대퇴골 골절 환자에서의급성신손상의 위험인자와 임상경과에 대한 연구는 부족하다. 이에 대퇴골 골절 환자에서의 임상양상, 검사실 소견 등을 비교하여 급성신손상의 위험인자와 임상경과를 조사하고자 하였다. 방법: 2006년 11월부터 2011년 12월까지 6년 동안 대퇴골골절로 의정부 성모병원 정형외과에 입원한 110명을 대상으로, 환자들의 병력, 검사실 소견, 방사선 소견, 수술 기록 등의 의학적 기록을 후향적으로 검토하여 대퇴골 골절 환자에서의 급성신손상의 발생빈도와 위험인자, 그리고 임상경과를 조사하였다. 결과: 전체 110명의 환자 중 급성신손상은 19명에서 발생하였다(17.3%). 재원 중 혈청 크레아티닌 최고치는 2.59 ±1.57 mg/dL으로 내원 8.2 ± 10.6일에 발생하였다. 급성신손상군 19명 중 2명이 사망하였고 2명은 만성 신부전증으로 진행되었으며, 13명에서 신기능이 정상으로 회복되었다. 회복까지는 약 19.7 ± 17.04일이 소요되었다. 급성신손상군은 정상 신기능군에 비하여 고령, 여성, 당뇨 환자가 많았으며, 검사실 소견에서 LDH (63.2% vs. 34.1%, p = 0.020), ESR (31.6%vs. 6.6%, p = 0.008), CRP (57.9% vs. 46.2%, p = 0.042)가 증가된 비율이 높았다. 또한 급성신손상군에서 수상 발생부터수술까지 걸리는 시간과 수술 후 재원 기간이 길었으며, 엔지오텐신 전환효소 억제제(ACEi)의 복용 빈도가 높았다(26.3%vs. 3.3%, p < 0.000). 이상 위험인자들에 대한 다변량 분석에서LDH 증가(p = 0.040, 95% C.I. 1.156-660.807), ESR 상승(p =0.035, 95% C.I. 1.176-77.957), ACEi 복용(p = 0.013, 95% C.I. 2.986-13216.654)이 급성신손상 발생을 유의하게 증가시키는위험인자로 확인되었다. 결론: 대퇴골 골절 환자에서 급성 신손상은 17.3%에서 발생하였고 이들 중 10%는 만성 신질환으로 진행되었다. 대퇴골 골절 환자에서 급성신손상 발생의 독립적인 위험인자는LDH, ESR 증가, ACEi 복용으로 나타났다. 따라서 대퇴골 골절 환자에서 급성신손상 발생 가능성을 염두에 두고 검사실소견 및 복용 약제를 감시하여 적극적인 초기 치료로 급성신손상을 조기에 치료하는 것이 중요하다고 생각한다.
Abstract
Background/Aims: Femoral fracture occurs most often in elderly patients and is highly associated with medical problems such as acute kidney injury (AKI); however no reports of AKI in femoral fracture patients have been published. This study was performed to identify risk factors and the clinical course of AKI in patients with femoral fracture. Methods: We retrospectively evaluated the medical records of 110 patients with femoral fracture between November 2006 and December 2011 at Uijeongbu St. Mary’s Hospital. We investigated the incidence and clinical course of AKI in femoral fracture patients and compared the clinical findings between AKI and normal kidney function (NKF) groups. Results: Of the 110 femoral fracture patients, AKI was observed in 19 (17.3%). The peak serum creatinine level in patients with AKI was 2.59 ± 1.57 mg/dL. Two of 19 patients with AKI died and two progressed to chronic kidney disease. When compared to the NKF group, the AKI group had a higher incidence of elevated lactate dehydrogenase (LDH) (63.2% vs. 34.1%, p = 0.020),erythrocyte sedimentation rate (ESR) (31.6% vs. 6.6%, p = 0.008), and C-reactive protein (57.9% vs. 46.2%, p = 0.042). The AKI group also had a longer hospitalization duration, and more patients were prescribed an angiotensin-converting-enzyme (ACE)inhibitor than in the NKF group. Multivariate analysis demonstrated elevated LDH, ESR and ACE inhibitor prescriptions as independent risk factors for AKI in patients with a femoral fracture. Conclusions: The incidence of AKI in patients with a femoral fracture was 17.3%, and AKI was associated with a longer clinical course. We recommend monitoring of laboratory findings and medications and early management to reduce the morbidity of patients with AKI.
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