Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Clin J Am Soc Nephrol. 2011 Jul;6(7):1744-51. doi: 10.2215/CJN.05480610.
Acute kidney injury (AKI) is a frequent complication in critically ill patients and sepsis is the most common contributing factor. We aimed to determine the risk factors associated with AKI development in patients with septic shock.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Observational cohort study consisted of consecutive adults with septic shock admitted to a medical intensive care unit (ICU) of a tertiary care academic hospital from July 2005 to September 2007. AKI was defined according to RIFLE criteria (urine output and creatinine criteria). Demographic, clinical, and treatment variables were reviewed. Main outcomes measured were AKI occurrence, all-cause hospital mortality, and hospital and ICU length of stay.
Three hundred ninety patients met inclusion criteria, of which 237 (61%) developed AKI. AKI development was independently associated with delay to initiation of adequate antibiotics, intra-abdominal sepsis, blood product transfusion, use of angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker, and body mass index (kg/m²). Higher baseline GFR and successful early goal directed resuscitation were associated with a decreased risk of AKI. Hospital mortality was significantly greater in patients who developed AKI (49 versus 34%).
In a contemporary cohort of patients with septic shock, both patient and health care delivery risk factors seemed to be important for AKI development.
急性肾损伤（AKI）是危重症患者的常见并发症，而脓毒症是最常见的致病因素。本研究旨在确定脓毒性休克患者发生 AKI 的相关危险因素。
设计、地点、参与者和测量方法：本观察性队列研究纳入了 2005 年 7 月至 2007 年 9 月期间入住一家三级学术医院内科重症监护病房（ICU）的连续脓毒性休克成年患者。AKI 根据 RIFLE 标准（尿量和肌酐标准）定义。回顾了人口统计学、临床和治疗变量。主要观察终点为 AKI 发生、全因住院死亡率、住院和 ICU 住院时间。
符合纳入标准的 390 例患者中，237 例（61%）发生 AKI。AKI 的发生与抗生素起始延迟、腹腔内脓毒症、血液制品输注、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的使用和体重指数（kg/m²）有关。较高的基线肾小球滤过率和早期目标导向复苏的成功与 AKI 风险降低相关。发生 AKI 的患者的住院死亡率显著更高（49% vs. 34%）。
在当代脓毒性休克患者队列中，患者和医疗保健提供相关的危险因素似乎对 AKI 的发生都很重要。
