Bates D W, Su L, Yu D T, Chertow G M, Seger D L, Gomes D R, Dasbach E J, Platt R
Division of General Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Clin Infect Dis. 2001 Mar 1;32(5):686-93. doi: 10.1086/319211. Epub 2001 Feb 21.
To assess the mortality and resource utilization that results from acute renal failure associated with amphotericin B therapy, 707 adult admissions in which parenteral amphotericin B therapy was given were studied at a tertiary-care hospital. Main outcome measures were mortality, length of stay, and costs; we controlled for potential confounders, including age, sex, insurance status, baseline creatinine level, length of stay before beginning amphotericin B therapy, and severity of illness. Among 707 admissions, there were 212 episodes (30%) of acute renal failure. When renal failure developed, the mortality rate was much higher: 54% versus 16% (adjusted odds of death, 6.6). When acute renal failure occurred, the mean adjusted increase in length of stay was 8.2 days, and the adjusted total cost was $29,823. Although residual confounding exists despite adjustment, the increases in resource utilization that we found are large and the associated mortality is high when acute renal failure occurs following amphotericin B therapy.
为评估两性霉素B治疗相关急性肾衰竭导致的死亡率和资源利用情况，一家三级护理医院对707例接受胃肠外两性霉素B治疗的成年住院患者进行了研究。主要结局指标为死亡率、住院时间和费用；我们对潜在混杂因素进行了控制，包括年龄、性别、保险状况、基线肌酐水平、开始两性霉素B治疗前的住院时间以及疾病严重程度。在707例住院患者中，有212例（30%）发生急性肾衰竭。肾衰竭发生时，死亡率要高得多：54% 对比16%（校正死亡比值比为6.6）。发生急性肾衰竭时，平均校正住院时间增加8.2天，校正总费用为29,823美元。尽管调整后仍存在残余混杂，但我们发现，两性霉素B治疗后发生急性肾衰竭时，资源利用增加幅度很大，且相关死亡率很高。
