Waikar Sushrut S, Curhan Gary C, Wald Ron, McCarthy Ellen P, Chertow Glenn M
Channing Laboratory, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115, USA.
J Am Soc Nephrol. 2006 Apr;17(4):1143-50. doi: 10.1681/ASN.2005091017. Epub 2006 Feb 22.
Despite improvements in intensive care and dialysis, some experts have concluded that outcomes associated with acute renal failure (ARF) have not improved significantly over time. ARF was studied in hospitalized patients between 1988 and 2002 using the Nationwide Inpatient Sample, a nationally representative sample of discharges from acute-care, nonfederal hospitals. During a 15-yr period, 5,563,381 discharges with ARF and 598,768 with ARF that required dialysis (ARF-D) were identified. Between 1988 and 2002, the incidence of ARF rose from 61 to 288 per 100,000 population; the incidence of ARF-D increased from 4 to 27 per 100,000 population. Between 1988 and 2002, in-hospital mortality declined steadily in patients with ARF (40.4 to 20.3%; P < 0.001) and in those with ARF-D (41.3 to 28.1%; P < 0.001). Compared with 1988 to 1992, the multivariable-adjusted odds ratio (OR) of death was lower in 1993 to 1997 (ARF: OR 0.62, 95% confidence interval [CI] 0.61 to 0.64; ARF-D: OR 0.63, 95% CI 0.59 to 0.66) and 1998 to 2002 (ARF: OR 0.40, 95% CI 0.39 to 0.41; ARF-D: OR 0.47, 95% CI 0.45 to 0.50). The percentage of patients who had ARF with a Deyo-Charlson comorbidity index of 3 or more increased from 16.4% in 1988 to 26.6% in 2002 (P < 0.001). This study provides evidence from an administrative database that the incidence of ARF and ARF-D is rising. Despite an increase in the degree of comorbidity, in-hospital mortality has declined.
尽管重症监护和透析技术有所进步，但一些专家得出结论，急性肾衰竭（ARF）的相关预后并未随时间显著改善。1988年至2002年期间，利用全国住院患者样本（一个来自急性护理、非联邦医院出院患者的全国代表性样本）对住院患者的急性肾衰竭进行了研究。在15年期间，共识别出5563381例急性肾衰竭出院病例和598768例需要透析的急性肾衰竭（ARF-D）出院病例。1988年至2002年期间，急性肾衰竭的发病率从每10万人61例升至288例；急性肾衰竭-透析的发病率从每10万人4例增至27例。1988年至2002年期间，急性肾衰竭患者（从40.4%降至20.3%；P<0.001）和急性肾衰竭-透析患者（从41.3%降至28.1%；P<0.001）的住院死亡率稳步下降。与1988年至1992年相比，1993年至1997年（急性肾衰竭：比值比0.62，95%置信区间[CI]0.61至0.64；急性肾衰竭-透析：比值比0.63，95%CI0.59至0.66）以及1998年至2002年（急性肾衰竭：比值比0.40，95%CI0.39至0.41；急性肾衰竭-透析：比值比0.47，95%CI0.45至0.50）死亡的多变量调整比值比更低。伴有Deyo-Charlson合并症指数为3或更高的急性肾衰竭患者比例从1988年的16.4%增至2002年的26.6%（P<0.001）。这项研究从一个管理数据库提供了证据，表明急性肾衰竭和急性肾衰竭-透析的发病率正在上升。尽管合并症程度增加，但住院死亡率有所下降。
