未被诊断的重症监护室急性肾损伤的肾功能转归分析

Renal function prognosis of undiagnosed acute kidney injury in critical care unit

目的：重症监护室患者的急性肾损伤（AKI）的未诊断率很高,本回顾性队列研究旨在分析未被诊断的AKI的临床转归。方法：对重症监护室患者住院期间的临床资料和出院后肾功能情况进行研究。用AKIN标准诊断AKI并分级。在检验信息系统中查询患者出院后的血肌酐值并估算肾小球滤过率,判断慢性肾脏病（CKD）分期。结果：共纳入281名患者,有92例（32.7%）符合AKIN标准的AKI,其中63例（68.5%）未被临床诊断为AKI。AKI是否被诊断与AKI在3月内恢复没有相关性（P=0.703）,但和第3年、第4年CKD分期进展相关。经AKI分级校正后,AKI未被诊断者第4年CKD分级进展的风险增加48.9%（OR=1.489,95%CI：1.105~1.932）。结论：重症监护室中大量的AKI未被临床诊断,这可能会促进远期CKD进展,临床上应高度重视AKI的诊断问题。

Objective：This is an observational retrospective cohort study designed to investigate the renal function prognosis of the undiagnosed AKI.Method：Clinical data of patients in critical care unit during hospital stay and after discharge were collected.The AKI was diagnosed and classified by AKIN criteria.The values of blood creatinine were searched from laboratory information system and the glomerular filtration rates were evaluated according to the creatinine values,which was used for the degradation of chronic kidney disease.Result：281patients were studied and 92patients（32.7%）were diagnosed of AKI by AKIN criteria,in whom 63patients（68.5%）with AKI were undiagnosed.Whether the AKI were diagnosed was not associated with the recovery of AKI（P=0.703）,however,it was related with the development of CKD in year 3and year 4.After adjusted with the degree of AKI,the undiagnosed AKI increased 48.9%risk of 4-year CKD development（95%CI：1.105-1.932）.Conclusion：The undiagnosed AKI was significant in critical care unit,which might promote long-term CKD development.The physicians should put a higher value on diagnosis of AKI.