中国危重症住院患者急性肾损伤的流行病学分析

摘要

Objective To investigate the epidemiological profile of acute kidney injury (AKI) in the Chinese critical patients. Methods The hospitalization data and serum creatinine data of critically ill adult patients were collected from 9 regional central hospitals across China in 2013. Kidney Disease Improving Global Outcomes (KDIGO 2012) criteria was used to define and stage AKI. The demographic characteristics of the patients, comorbidities, stage of AKI, in-hospital outcomes and risk factors were retrospectively analyzed. Results Of the total of 14 305 critically ill patients included in the study, 4298 (30.04%) were identified to have AKI, including 2240 (52.1%) in stage 1, 845 (19.7%) in stage 2, and 1213 (28.2%) in stage 3. The in-hospital mortality rate was 16.7%(716/4298) and the odds ratio for death was 7.59 (95%CI 6.54-8.79, P<0.001). The length of hospital stay, daily cost, and mortality rate were associated with the stage of AKI. Multivariate analysis identified chronic kidney disease (OR=5.45, 95%CI: 4.71-6.32, P<0.001), extra-renal organ failure (OR=12.57, 95%CI: 11.24-14.07, P<0.001), shock (OR=2.44, 95%CI:2.01-2.96, P<0.001) and cardiac surgery (OR=5.96, 95%CI:5.16-6.87, P<0.001) as the independent risk factors for AKI. Only 5.4%of the AKI patients whose serum creatinine change met the KDIGO criteria during hospitalization received the diagnosis of AKI upon discharge. Conclusion AKI is common in critically ill patients and associated with high mortality rates and poor outcomes. The stage of AKI is related with the in-hospital outcomes of the patients. Chronic kidney disease, extra-renal organ failure, shock and cardiac surgery are the major risk factors for AKI in these patients. Missed diagnosis occurs in most of the AKI cases, which urges more awareness of the condition in the critically ill patients during hospitalization.%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, P<0.001）。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, P<0.001），肾外器官衰竭（OR=12.57,95% CI：11.24~14.07, P<0.001），休克（OR=2.44,95% CI：2.01~2.96, P<0.001），心脏手术（OR=5.96,95% CI：5.16~6.87, P<0.001）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。