Chertow Glenn M, Burdick Elisabeth, Honour Melissa, Bonventre Joseph V, Bates David W
Division of Nephrology, Department of Medicine, University of California San Francisco, 94118-1211, USA.
J Am Soc Nephrol. 2005 Nov;16(11):3365-70. doi: 10.1681/ASN.2004090740. Epub 2005 Sep 21.
The marginal effects of acute kidney injury on in-hospital mortality, length of stay (LOS), and costs have not been well described. A consecutive sample of 19,982 adults who were admitted to an urban academic medical center, including 9210 who had two or more serum creatinine (SCr) determinations, was evaluated. The presence and degree of acute kidney injury were assessed using absolute and relative increases from baseline to peak SCr concentration during hospitalization. Large increases in SCr concentration were relatively rare (e.g., >or=2.0 mg/dl in 105 [1%] patients), whereas more modest increases in SCr were common (e.g., >or=0.5 mg/dl in 1237 [13%] patients). Modest changes in SCr were significantly associated with mortality, LOS, and costs, even after adjustment for age, gender, admission International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis, severity of illness (diagnosis-related group weight), and chronic kidney disease. For example, an increase in SCr >or=0.5 mg/dl was associated with a 6.5-fold (95% confidence interval 5.0 to 8.5) increase in the odds of death, a 3.5-d increase in LOS, and nearly 7500 dollars in excess hospital costs. Acute kidney injury is associated with significantly increased mortality, LOS, and costs across a broad spectrum of conditions. Moreover, outcomes are related directly to the severity of acute kidney injury, whether characterized by nominal or percentage changes in serum creatinine.
急性肾损伤对住院死亡率、住院时间(LOS)及费用的边际效应尚未得到充分描述。我们评估了一家城市学术医疗中心收治的19982例成年患者的连续样本,其中9210例患者进行了两次或更多次血清肌酐(SCr)测定。通过计算住院期间从基线到SCr峰值浓度的绝对和相对升高来评估急性肾损伤的存在及程度。SCr浓度大幅升高相对少见(例如,105例[1%]患者升高≥2.0mg/dl),而SCr适度升高较为常见(例如,1237例[13%]患者升高≥0.5mg/dl)。即使在调整了年龄、性别、入院时国际疾病分类第九版临床修订本诊断、疾病严重程度(诊断相关组权重)及慢性肾脏病后,SCr的适度变化仍与死亡率、住院时间及费用显著相关。例如,SCr升高≥0.5mg/dl与死亡几率增加6.5倍(95%置信区间5.0至8.5)、住院时间延长3.5天及医院额外费用近7500美元相关。急性肾损伤在广泛的病症中均与死亡率、住院时间及费用的显著增加相关。此外,无论以血清肌酐的名义变化还是百分比变化来表征,结局都与急性肾损伤的严重程度直接相关。