甲型 H1N1 流感患者的急性肾损伤。
Acute kidney injury in patients with influenza A (H1N1) 2009.
机构信息
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
出版信息
Intensive Care Med. 2011 May;37(5):763-7. doi: 10.1007/s00134-011-2166-8. Epub 2011 Mar 11.
OBJECTIVE
We aim to evaluate the incidence and outcome of acute kidney injury (AKI) among critically ill adult patients with H1N1 2009 infection.
DESIGN AND PATIENTS
From a prospectively collected influenza A (H1N1) 2009 bi-national, we identified 671 adult patients admitted to intensive care unit (ICU) from June 1 to August 31, 2009. Of these, 628 (93.6%) had admission and/or peak serum creatinine values during ICU stay. We defined AKI according to the creatinine criteria of the RIFLE classification.
RESULTS
Of 628 adult patients, 211 [33.6%, 95% confidence interval (CI) 29.8-37.4%] had AKI: 41 (6.5%) risk, 56 (8.9%) injury and 114 (18.2%) failure. Of all 211 AKI patients, 76 [36.0% (29.4-42.6%)] died in hospital (36.6% in risk, 25.0% in injury and 41.3% in failure group) compared with 33 of 408 (8.1%) patients without AKI. Among the 33 AKI patients treated with renal replacement therapy, 13 died (39.4%). Mechanical ventilation [odds ratio (OR) 3.62 (2.07-6.34)], any severe co-morbidity (OR 2.36, 95% CI 1.15-3.71), age (OR 1.02, 95% CI 1.01-1.03 per 1 year increase), and AKI (OR 6.69, 95% CI 4.25-10.55) were independently associated with hospital mortality.
CONCLUSIONS
Acute kidney injury appears common in H1N1 2009 infected patients and is independently associated with an increased risk of hospital mortality.
目的
评估甲型 H1N1 2009 流感病毒感染的成年危重症患者并发急性肾损伤（AKI）的发生率和结局。
设计和患者
我们从一项前瞻性收集的甲型 H1N1 2009 流感病毒的跨国研究中，纳入了 2009 年 6 月 1 日至 8 月 31 日期间入住重症监护病房（ICU）的 671 例成年患者。其中，628 例（93.6%）患者在 ICU 住院期间有入院时和/或峰值血清肌酐值。我们根据 RIFLE 分类的肌酐标准定义 AKI。
结果
628 例成年患者中，211 例（33.6%，95%置信区间[CI]为 29.8%37.4%）发生 AKI：41 例（6.5%）为风险，56 例（8.9%）为损伤，114 例（18.2%）为衰竭。在所有 211 例 AKI 患者中，76 例（36.0%[29.4%42.6%]）在院内死亡（风险组为 36.6%，损伤组为 25.0%，衰竭组为 41.3%），而在 408 例无 AKI 患者中，仅 33 例（8.1%）死亡。在接受肾脏替代治疗的 33 例 AKI 患者中，有 13 例死亡（39.4%）。机械通气[比值比（OR）3.62（2.076.34）]、任何严重合并症（OR 2.36，95%CI 1.153.71）、年龄（OR 1.02，95%CI 1.011.03/每年增加 1 岁）和 AKI（OR 6.69，95%CI 4.2510.55）与住院死亡率独立相关。
结论
甲型 H1N1 2009 感染患者中 AKI 似乎很常见，且与住院死亡率增加独立相关。
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