Lahoti Amit, Nates Joseph L, Wakefield Chris D, Price Kristen J, Salahudeen Abdulla K
Department of General Internal Medicine, Section of Nephrology, The University of Texas M.D. Anderson Cancer Center, PO Box 301402, FCT 13.6068, Houston, TX, 77230-1402, USA.
J Support Oncol. 2011 Jul-Aug;9(4):149-55. doi: 10.1016/j.suponc.2011.03.008.
Acute kidney injury (AKI) is a common complication in critically ill patients with cancer. The RIFLE criteria define three levels of AKI based on the percent increase in serum creatinine (Scr) from baseline: risk (> or = 50%), injury (> or = 100%), and failure (> or = 200% or requiring dialysis). The utility of the RIFLE criteria in critically ill patients with cancer is not known.
To examine the incidence, outcomes, and costs associated with AKI in critically ill patients with cancer.
We retrospectively analyzed all patients admitted to a single-center ICU over a 13-month period with a baseline Scr < or = 1.5 mg/dL (n = 2,398). Kaplan-Meier estimates for survival by RIFLE category were calculated. Logistic regression was used to determine the association of AKI on 60-day mortality. A log-linear regression model was used for economic analysis. Costs were assessed by hospital charges from the provider's perspective.
For the risk, injury, and failure categories of AKI, incidence rates were 6%, 2.8%, and 3.7%; 60-day survival estimates were 62%, 45%, and 14%; and adjusted odds ratios for 60-day mortality were 2.3, 3, and 14.3, respectively (P < or = 0.001 compared to patients without AKI). Hematologic malignancy and hematopoietic cell transplant were not associated with mortality in the adjusted analysis. Hospital cost increased by 0.16% per 1% increase in creatinine and by 21% for patients requiring dialysis.
Retrospective analysis. Single-center study. No adjustment by cost-to-charge ratios.
AKI is associated with higher mortality and costs in critically ill patients with cancer.
急性肾损伤（AKI）是重症癌症患者常见的并发症。RIFLE标准根据血清肌酐（Scr）较基线水平升高的百分比定义了AKI的三个级别：风险（≥50%）、损伤（≥100%）和衰竭（≥200%或需要透析）。RIFLE标准在重症癌症患者中的实用性尚不清楚。
研究重症癌症患者中与AKI相关的发病率、结局和费用。
我们回顾性分析了在13个月期间入住单中心重症监护病房（ICU）且基线Scr≤1.5mg/dL的所有患者（n = 2398）。计算了按RIFLE类别划分的生存的Kaplan-Meier估计值。采用逻辑回归确定AKI与60天死亡率之间的关联。使用对数线性回归模型进行经济分析。从提供者角度通过医院收费评估费用。
对于AKI的风险、损伤和衰竭类别，发病率分别为6%、2.8%和3.7%；60天生存估计值分别为62%、45%和14%；60天死亡率的调整比值比分别为2.3、3和14.3（与无AKI的患者相比，P≤0.001）。在调整分析中，血液系统恶性肿瘤和造血细胞移植与死亡率无关。肌酐每增加1%，医院费用增加0.16%，需要透析的患者费用增加21%。
回顾性分析。单中心研究。未按成本收费比进行调整。
AKI与重症癌症患者较高的死亡率和费用相关。
