Bagshaw Sean M, Uchino Shigehiko, Bellomo Rinaldo, Morimatsu Hiroshi, Morgera Stanislao, Schetz Miet, Tan Ian, Bouman Catherine, Macedo Ettiene, Gibney Noel, Tolwani Ashita, Oudemans-van Straaten Heleen M, Ronco Claudio, Kellum John A
Department of Intensive Care and Department of Medicine, Austin & Repatriation Medical Centre, Melbourne, Australia.
Clin J Am Soc Nephrol. 2007 May;2(3):431-9. doi: 10.2215/CJN.03681106. Epub 2007 Mar 21.
Sepsis is the most common cause of acute kidney injury (AKI) in critical illness, but there is limited information on septic AKI. A prospective, observational study of critically ill patients with septic and nonseptic AKI was performed from September 2000 to December 2001 at 54 hospitals in 23 countries. A total of 1753 patients were enrolled. Sepsis was considered the cause in 833 (47.5%); the predominant sources of sepsis were chest and abdominal (54.3%). Septic AKI was associated with greater aberrations in hemodynamics and laboratory parameters, greater severity of illness, and higher need for mechanical ventilation and vasoactive therapy. There was no difference in enrollment kidney function or in the proportion who received renal replacement therapy (RRT; 72 versus 71%; P = 0.83). Oliguria was more common in septic AKI (67 versus 57%; P < 0.001). Septic AKI had a higher in-hospital case-fatality rate compared with nonseptic AKI (70.2 versus 51.8%; P < 0.001). After adjustment for covariates, septic AKI remained associated with higher odds for death (1.48; 95% confidence interval 1.17 to 1.89; P = 0.001). Median (IQR) duration of hospital stay for survivors (37 [19 to 59] versus 21 [12 to 42] d; P < 0.0001) was longer for septic AKI. There was a trend to lower serum creatinine (106 [73 to 158] versus 121 [88 to 184] mumol/L; P = 0.01) and RRT dependence (9 versus 14%; P = 0.052) at hospital discharge for septic AKI. Patients with septic AKI were sicker and had a higher burden of illness and greater abnormalities in acute physiology. Patients with septic AKI had an increased risk for death and longer duration of hospitalization yet showed trends toward greater renal recovery and independence from RRT.
脓毒症是危重症患者急性肾损伤（AKI）最常见的病因，但关于脓毒症相关性急性肾损伤的信息有限。2000年9月至2001年12月，在23个国家的54家医院对患有脓毒症相关性和非脓毒症相关性急性肾损伤的危重症患者进行了一项前瞻性观察研究。共纳入1753例患者。833例（47.5%）患者被认为病因是脓毒症；脓毒症的主要来源是胸部和腹部（54.3%）。脓毒症相关性急性肾损伤与血流动力学和实验室参数的更大异常、更严重的病情以及对机械通气和血管活性治疗的更高需求相关。入组时的肾功能或接受肾脏替代治疗（RRT）的比例没有差异（分别为72%和71%；P = 0.83）。少尿在脓毒症相关性急性肾损伤中更常见（分别为67%和57%；P < 0.001）。与非脓毒症相关性急性肾损伤相比，脓毒症相关性急性肾损伤的院内病死率更高（分别为70.2%和51.8%；P < 0.001）。在对协变量进行调整后，脓毒症相关性急性肾损伤仍然与更高的死亡几率相关（1.48；95%置信区间为1.17至1.89；P = 0.001）。脓毒症相关性急性肾损伤幸存者的中位（四分位间距）住院时间更长（分别为37 [19至59]天和21 [12至42]天；P < 0.0001）。脓毒症相关性急性肾损伤患者出院时血清肌酐有降低趋势（分别为106 [73至158] μmol/L和121 [88至184] μmol/L；P = 0.01）以及对RRT的依赖有降低趋势（分别为9%和14%；P = 0.052）。脓毒症相关性急性肾损伤患者病情更重，疾病负担更高，急性生理学方面的异常更大。脓毒症相关性急性肾损伤患者死亡风险增加，住院时间更长，但显示出肾脏恢复更好和摆脱RRT依赖的趋势。
