目的探讨院内老年急性肾损伤(acute kidney injury,AKI)患者的临床特点及短期预后。方法本研究收集2013 年1 月～2014 年9 月上海市第九人民医院住院期间发生AKI 患者的临床资料，分析老年患者发生AKI 的临床特点及90 天死亡的危险因素。结果共纳入368 例院内AKI 患者，老年AKI 患者201 例，90 天死亡率34.8%，非老年AKI 患者167 例，90 天死亡率33.5%。感染及肾脏缺血是老年AKI 患者的最常见病因。多因素COX 风险模型分析显示，血小板(HR 0.996，95% CI 0.993～0.999，P=0.005)、C 反应蛋白(HR 1.011，95% CI 1.006～1.015，P＜0.001)、平均动脉压(HR 0.981，95% CI0.967～0.996，P=0.001)、APACHEII 评分(HR 1.053，95% CI 1.023～1.084，P＜0.001)、伴AKI 合并症(HR 2.406，95% CI 1.220～4.745，P=0.011)是老年AKI 患者90 天死亡的独立危险因素。结论低血小板、低平均动脉压、高C 反应蛋白、高APACHEII 评分及AKI 合并症为住院老年AKI 患者短期死亡的独立危险因素。

Objective To investigate the clinical characteristics and short-term prognosis of hospital-acquired acute kidney injury (AKI) in the elderly. Methods The clinical data of hospital-acquired AKI patients admitted in the Ninth People’s Hospital from January 2013 to September 2014 were collected, and the elderly patients with AKI were then identified. Their clinical characteristics and risk factors for mortality within 90 days were analyzed. Results A total of 368 hospital-acquired AKI patients were identified. Of all the elderly patients (n=201), the mortality within 90 days was 34.8%. Among the non-elderly patients, the mortality within
90 days was 33.5%. The main causes of death for elderly patients were ischemia and infection. Multivariate analysis performed by Cox model showed that platelet (HR=0.996, 95% CI 0.993～0.999, P=0.005), C-reactive protein (HR=1.011, 95% CI 1.006～1.015, P＜0.001), mean arterial blood pressure (HR=0.981, 95% CI 0.967～0.996, P=0.001), APACHE II score (HR=1.053, 95% CI 1.023～1.084, P＜0.001), AKI complication (HR=2.406, 95% CI 1.220～4.745, P=0.011) were the independent variables predicting survival within 90 days in elderly AKI patients. Conclusions Lower platelet, higher C- reactive protein, lower mean arterial blood pressure, higher APACHE II score, and AKI complications were the independent risk factors for shortterm prognosis in elderly AKI patients.