Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA.
Clin J Am Soc Nephrol. 2011 Jul;6(7):1556-65. doi: 10.2215/CJN.08470910. Epub 2011 Jun 23.
Serum creatinine (sCr) increments currently used to define acute kidney injury (AKI) do not take into consideration the baseline level of kidney function. The objective of this study was to establish whether baseline estimated GFR (eGFR) provides additional risk stratification to sCr-based increments for defining AKI.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: 29,645 adults hospitalized at an acute care facility were analyzed. Hospital-acquired AKI was defined by calculating the difference between the nadir and subsequent peak sCr.
Different thresholds of nadir-to-peak sCr were found to be independently associated with increased in-hospital mortality according to baseline eGFR strata. A nadir-to-peak sCr minimum threshold of ≥0.2, ≥0.3, and ≥0.5 mg/dl was required to be independently associated with increased in-hospital mortality among patients with baseline eGFR ≥60 ml/min per 1.73 m² (odds ratio [OR] 1.67; 95% confidence interval [CI] 1.13 to 2.47), 30 to 59 ml/min per 1.73 m² (OR 2.69; 95% CI, 1.82 to 3.97), and <30 ml/min per 1.73 m² (OR 2.15; 95% CI 1.02 to 4.51), respectively. There was a significant interaction between the nadir-to-peak sCr and baseline eGFR for in-hospital mortality (P < 0.001). Using these thresholds, survivors of AKI episodes had an increased hospital length of stay and were more likely to be discharged to a facility rather than home. Sensitivity analyses showed a significant interaction between baseline eGFR strata and relative increases in sCr, as well as absolute and relative decreases in eGFR for in-hospital mortality (P < 0.001). Conclusions This study suggests that future sCr-based definitions of AKI should take into consideration baseline eGFR.
目前用于定义急性肾损伤（AKI）的血清肌酐（sCr）升高并未考虑到肾功能的基线水平。本研究旨在确定基线估算肾小球滤过率（eGFR）是否为基于 sCr 升高的 AKI 定义提供了额外的风险分层。
设计、设置、参与者和测量：分析了 29645 名在急性护理机构住院的成年人。通过计算最低值和随后的峰值 sCr 之间的差异来定义医院获得性 AKI。
根据基线 eGFR 分层，发现不同的最低值-峰值 sCr 阈值与住院死亡率的增加独立相关。在基线 eGFR≥60 ml/min/1.73 m²的患者中，最低值-峰值 sCr 的最小阈值≥0.2、≥0.3 和≥0.5 mg/dl 与住院死亡率的增加独立相关（比值比[OR] 1.67；95%置信区间[CI] 1.13 至 2.47）、30 至 59 ml/min/1.73 m²（OR 2.69；95% CI，1.82 至 3.97）和 <30 ml/min/1.73 m²（OR 2.15；95% CI 1.02 至 4.51）。最低值-峰值 sCr 与基线 eGFR 对住院死亡率有显著的交互作用（P<0.001）。使用这些阈值，AKI 发作的幸存者住院时间延长，更有可能被送往医疗机构而不是家中。敏感性分析显示，基线 eGFR 分层与 sCr 的相对升高以及 eGFR 的绝对和相对下降对住院死亡率有显著的交互作用（P<0.001）。结论：本研究表明，未来基于 sCr 的 AKI 定义应考虑基线 eGFR。
