Shema Lilach, Ore Liora, Geron Ronit, Kristal Batya
Department of Pediatrics, Western Galilee Hospital, Nahariya, Israel.
Isr Med Assoc J. 2009 May;11(5):269-74.
Acute kidney injury remains a common significant clinical problem. Yet there are scant data in Israel on the incidence of hospital-acquired AKI and on diagnosis validity.
To describe the epidemiology of AKI among hospitalized patients in the Western Galilee Hospital, Nahariya, compare discharge summaries to laboratory diagnosis, and investigate the impact of AKI on mortality and length of stay.
Computerized medical and laboratory data of 34,802 hospitalized subjects were collected. AKI was diagnosed according to three different definitions. We calculated the sensitivity and specificity of AKI based on ICD-9 diagnosis compared to patient's laboratory data as the gold standard.
The overall AKI annual incidence rate was 1-5.1%, depending on the AKI definition used. The incidence of AKI based on ICD-9 diagnosis was significantly lower compared to the laboratory-based diagnosis. Average in-hospital length of stay was 2.4 times longer among patients with AKI compared to subjects without this condition. Furthermore, the in-hospital death rate among AKI patients was 14 times higher than among non-AKI hospitalized subjects, with a positive association between AKI severity and risk of death.
Using AKI laboratory diagnosis as the gold standard revealed ICD-9 diagnosis to be 9.1% sensitive and 99.4% specific. Hospital-acquired AKI is a major contributor to prolonged length of stay and high mortality rates; therefore, interventions to reduce in-hospital disease incidence are required.
急性肾损伤仍然是一个常见的重大临床问题。然而，以色列关于医院获得性急性肾损伤的发病率及诊断有效性的数据却很少。
描述纳哈里亚市加利利西部医院住院患者中急性肾损伤的流行病学情况，将出院小结与实验室诊断进行比较，并调查急性肾损伤对死亡率和住院时间的影响。
收集了34802名住院患者的计算机化医疗和实验室数据。根据三种不同定义诊断急性肾损伤。我们将基于国际疾病分类第九版（ICD - 9）诊断的急性肾损伤的敏感性和特异性与作为金标准的患者实验室数据进行了比较。
根据所使用的急性肾损伤定义，总体急性肾损伤年发病率为1% - 5.1%。基于ICD - 9诊断的急性肾损伤发病率明显低于基于实验室诊断的发病率。与未患急性肾损伤的患者相比，急性肾损伤患者的平均住院时间长2.4倍。此外，急性肾损伤患者的院内死亡率比非急性肾损伤住院患者高14倍，急性肾损伤严重程度与死亡风险之间存在正相关。
以急性肾损伤实验室诊断作为金标准显示，ICD - 9诊断的敏感性为9.1%，特异性为99.4%。医院获得性急性肾损伤是住院时间延长和高死亡率的主要原因；因此，需要采取干预措施以降低院内疾病发病率。
