住院患者急性肾损伤发病率和预后的横断面调查

Incidence and outcome of acute kidney injury in hospitalized patients in a single center

目的 了解住院患者急性肾损伤（AKI）的发病情况及其预后,以期降低AKI患者的发病率和病死率。方法 选取2014年11月3-9日于复旦大学附属中山医院住院的2 563例成年（年龄≥18岁）患者,按照改善全球肾脏病预后组织标准筛查出AKI患者92例（3.6%）,并将其分为AKI 1、2和3期,随访AKI患者确诊后28d的预后,并分析其危险因素。结果 AKI患者中,男65例、女27例,平均年龄为（64.1±17.2）岁,11例（11.9%）患者行肾脏替代治疗（RRT）。23例为社区获得性AKI（CA-AKI）患者,前3位病因为应用药物（26.1%）、感染（21.7%）和心力衰竭（17.4%）;69例为医院获得性AKI（HA-AKI）患者,前3位病因为手术（62.7%）、感染（14.5%）和药物（8.7%）。AKI患者的年龄显著大于非AKI患者（P〈0.05）,住院天数显著多于非AKI患者（P〈0.05）,住院费用显著高于非AKI患者（P〈0.05）。确诊后28d,AKI患者的病死率为7.6%;肾功能完全恢复占28.3%,部分恢复占23.9%,未恢复占21.7%,多因素Logistic回归分析显示,AKI分期（OR=4.448,95%CI为1.541-12.840,P=0.006）、恶性肿瘤（OR=13.798,95%CI为1.791-36.287,P=0.012）和血白蛋白（OR=0.763,95%CI为0.625-0.932,P=0.008）是AKI患者死亡的独立危险因素。结论 住院患者AKI的发病率高,肾脏预后差,AKI患者住院时间显著延长,住院费用和病死率显著升高。手术是HA-AKI的最常见病因,重视围术期处理和肾功能随访对于早期诊断和防治AKI极其重要。同时,亟需加强对AKI患者的长期随访。

Objective To determine the incidence and mortality rate of acute kidney injury （AKI） among hospitalized adult patients. Methods According to the Improving Global Outcomes（KDIGO） criteria, 92（3.6%） patients were diagnosed as AKI among 2 563 patients （aged ≥ 18 years） admitted to our hospital between November 3rd, 2014 and November 9th, 2014. Short-term （28 days） outcome was evaluated and the possible risk factors were analyzed. Results There were 65 males and 27 females with an average age of （64. 1 ± 17.2） years. Renal replacement therapy was performed in 11 patients （11.9% ）. There were 23 patients suffering from community-acquired AKI, and the top three causes were nephrotoxic drugs （26.1% ）, infection （21.7 % ） and heart failure （17. 4%）. There were 69 patients with hospital-acquired AKI, and the leading causes were surgery （62.7 % ）, infection （ 14.5 % ） and nephrotoxic drugs （8.7 % ）. The age, length of stay （LOS） and cost of the AKI patients were significantly increased as compared with those without AKI （all P〈0.05）. The 28-day mortality of AKI was 7.6%. Complete, partial and no renal recovery was observed in 28.3%, 23.9% and 21.7% of AKI patients, respectively. The results of multivariate logistic regression showed that AKI stage （KDIGO criteria, OR =4.448, 95%CI =1.541- 12.840, P=0.006）, malignant tumor （OR= 13.798, 95%CI= 1.791 -36.287, P = 0. 012） and albumin （ OR = 0. 763, 95% CI = 0. 625 - 0. 932, P = 0. 008） were independent risk factors of 28- day mortality. Conclusion AKI is prevalent in inpatients of our hospital and the renal outcome is poor. The mortality, LOS and hospital cost are significantly increased in AKI patients. Surgery is the most common cause of hospital-acquired AKI. It is very important to emphasize perioperative management and renal function assessment for early diagnosis and prevention of AKI. Moreover, it is essential that long-term follow-up is performed in AKI patients. Outcomes are related directly to the severity of AKI.