中国危重症住院患者急性肾损伤的流行病学分析

发布时间：2018-03-02 12:10

本文选题：急性肾损伤　切入点：危重症　出处：《南方医科大学学报》2016年06期 　论文类型：期刊论文

【摘要】：目的明确中国危重症住院患者中急性肾损伤(AKI)的流行病学现状,包括AKI的发生率、临床特征、院内预后及相关危险因素。方法收集全国9家地区性中心医院2013年间所有成人危重症住院患者的住院病历资料及血肌酐检验资料,AKI诊断及分期采用改善全球肾脏病预后组织(KDIGO)2012年提出的AKI诊断标准。回顾性分析所有纳入患者的人口学特征、临床合并症、AKI分期、院内预后、危险因素等指标。结果符合入选标准的危重症患者共14305人,其中4298人(30.04%)发生AKI,AKI 1、2、3期患者分别为2240(52.1%)、845(19.7%)及1213(28.2%)。AKI患者死亡716人,院内死亡率为16.7%,死亡风险优势比为7.59(95%CI 6.54~8.79,P0.001)。随着AKI分期升高,患者住院天数延长、日均住院花费增多、死亡率升高(P值均小于0.001)。多因素Logistic回归分析发现慢性肾脏病(CKD)(OR=5.45,95%CI:4.71~6.32,P0.001),肾外器官衰竭(OR=12.57,95%CI:11.24~14.07,P0.001),休克(OR=2.44,95%CI:2.01~2.96,P0.001),心脏手术(OR=5.96,95%CI:5.16~6.87,P0.001)等是危重症患者发生AKI的独立危险因素。在血肌酐变化符合KDIGO诊断标准的AKI人群中,仅有5.4%的患者出院有"AKI"诊断。结论危重症患者中AKI发生率高,预后差。AKI分期与院内预后相关,CKD、肾外器官衰竭、休克、心脏手术是危重症住院患者AKI主要的危险因素。住院期间多数AKI被漏诊,我们应提高对住院患者尤其是危重症患者AKI的重视。
[Abstract]:Objective to identify the epidemiological status of acute renal injury (AKI) in critically ill hospitalized patients in China, including the incidence and clinical characteristics of AKI. Methods Inpatient medical records and serum creatinine test data of all adult critically ill inpatients in 9 regional central hospitals throughout the country during 2013 were collected. AKI diagnosis and staging were used to improve the global kidney. AKI diagnostic criteria were proposed by KDIGO in 2012. The demographic characteristics of all patients included were retrospectively analyzed. Results A total of 14305 critically ill patients met the inclusion criteria, including 4298patients with AKI 1 and 30.04) with AKI AKI stage 1: 52.1A = 845 / 19.7a) and 121328.22+ .AKI patients died in 716 patients, respectively, in the patients with clinical complications such as AKI staging, nosocomial prognosis, risk factors and so on. The mortality rate in hospital was 16.70.The odds ratio of death risk was 7.59c95 / 95 CI 6.548.79m P0.001. With the increase of AKI stage, the length of hospital stay was prolonged, and the average daily hospitalization cost increased. Multivariate Logistic regression analysis showed that Logistic regression analysis showed that chronic kidney disease patients with chronic kidney disease had an OR5.45 ~ 95% CI4.71 ~ 6.32U P 0.001, OR 12.57 ~ 95% CI: 11.24 ~ 14.07% P 0.001, shock OR2.4495 ~ (95) CI 2.961 ~ 2.96 P0.001, heart operation OR5.96 ~ 95CIO 5.165.166.87p 0.001), and so on. The changes of serum creatinine accord with KDIGO diagnosis, etc. The risk factors of developing AKI in critically ill patients are found to be the same as those of the patients undergoing cardiac surgery (OR5.96-95CIO 5.165.165.165.87P0.001), etc. The risk factors of AKI in critical patients are as follows: the blood creatinine changes are in accordance with the diagnosis of KDIGO. In a standard-breaking AKI population, Only 5.4% of the patients were discharged from hospital with "AKI" diagnosis. Conclusion the incidence of AKI is high in the critically ill patients, the prognosis is poor. AKI staging is related to the prognosis in the hospital, extrarenal organ failure, shock, etc. Cardiac surgery is the main risk factor for AKI in critically ill inpatients. Most of AKI are missed during hospitalization. We should pay more attention to AKI in hospitalized patients, especially in critically ill patients.
【作者单位】：南方医科大学南方医院肾内科//国家肾脏病临床研究中心//器官衰竭防治国家重点实验室;
【基金】：国家自然科学基金重点项目(81430016) 国家科技支撑计划(2015BAI2B07)~~
【分类号】：R459.7;R692

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