| Objective:In order to provide a basis for prolonging the survival time of maintenance hemodialysis(MHD)patients and reducing the incidence of infection,collecting the clinical data of patients admitted for infection,and analyzing the risk factors for infection.Methods:Baseline data of patients with end-stage renal disease who underwent long-term hemodialysis in our hospital from December 2013 to February 2018 were collected by electronic medical record system,and medical records were followed up for at least one year,with the deadline of February 2019.The patients were divided into an infected group and non-infected group according to whether there was an infection or not.The baseline information of patients including general information(age,gender,etc.),clinical data(past medical history,history of smoking,drug combination,for the first time dialysis whether infection,hospitalization duration,hemodialysis vascular access for the first time,the primary disease,hemoglobin,white blood cells,neutrophils,albumin,urea,creatinine,parathyroid hormone and so on,a total of 44 indicators).And the hospitalization time,hospitalization cost,antibiotic selection and other indicators of patients with infection.The primary endpoint was all-cause death and withdrawal from hemodialysis.Baseline data characteristics were analyzed using frequency and percentage analysis.T test and chi-square test were used to compare the data differences between the infected group and the non-infected group.Single factor logistics analysis was used to analyze the risk factors of MHD patients’ infection,and multi-factor logistics analysis was used to analyze the independent risk factors influencing the infection of patients.Patients were divided into three groups according to the severity of anemia,and medical records were followed up for at least 1 year: HB1 group(mild anemia,Hb>90g/L),HB2 group(moderate anemia,90g/L≥Hb ≥60g/L),and H3 group(severe anemia,59g/L≥Hb≥30g/L).COX proportional risk model was used to plot the survival function of the infection-free state.Model 1: age,gender,model 2: age,gender,diabetes,smoking,use of erythropoietin,oral iron,oral folic acid,mean arterial pressure,length of first dialysis hospitalization,model 3: leukocyte,platelet,albumin,creatinine,uric acid,urea,blood glucose.Results:A total of 392 patients were included in the study,255 were male,accounting for 65.1%.The average age was 59.39 15.28 years old.The average dialysis age was 30.18 12.97 months.The infection rate of diabetic nephropathy was the highest(32.2%).The main site of infection was the lung,accounting for 78.4%,which was far higher than the catheter related infection in the second position.Quinolones and cephalosporin antibiotics were often used as the preferred drugs after infection.Single-factor logistics analysis indicated that low hemoglobin,low albumin,age,length of first dialysis hospitalization,and concurrent infection during the first dialysis hospitalization were risk factors for infection.Multi-factor logistics analysis found that age,length of hospital stay at the time of first dialysis,and hemoglobin were independent risk factors for infection in MHD patients,and hemoglobin was a protective factor for patients.The HB3 group(59g/L Hb 30g/L)was found to have the highest possibility of infection through COX proportional risk model analysis.Conclusion:1.The incidence of infection is high in patients with maintenance hemodialysis.The incidence of pulmonary infection is much higher than in other types of infection.2.Age,low hemoglobin and low albumin are high-risk factors for MHD patients to be prone to co-infection,and MHD patients with co-infection during the first dialysis are more likely to be infected again.3.Patients with severe anemia are more likely to be infected.4.For the elderly patients with concomitant infection during the first dialysis,special attention should be paid to the treatment and follow-up of anemia if severe anemia is concomitant,and effective medical measures should be taken to prevent infection or reduce the occurrence of infection. |
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