Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong, and Saint Mary's Medicine, Nursing and Management College, Yilan, Taiwan.
PLoS One. 2012;7(8):e42952. doi: 10.1371/journal.pone.0042952. Epub 2012 Aug 28.
Postoperative acute kidney injury (AKI) is associated with poor outcomes in surgical patients. This study aims to evaluate whether the timing of renal replacement therapy (RRT) initiation affects the in-hospital mortality of patients with postoperative AKI.
This multicenter retrospective observational study, which was conducted in the intensive care units (ICUs) in a tertiary hospital (National Taiwan University Hospital) and its branch hospitals in Taiwan between January, 2002, and April, 2009, included adult patients with postoperative AKI who underwent RRT for predefined indications. The demographic data, comorbid diseases, types of surgery and RRT, and the indications for RRT were documented. Patients were categorized according to the period of time between the ICU admission and RRT initiation as the early (EG, ≦1 day), intermediate (IG, 2-3 days), and late (LG, ≧4 days) groups. The in-hospital mortality rate censored at 180 day was defined as the endpoint.
Six hundred forty-eight patients (418 men, mean age 63.0±15.9 years) were enrolled, and 379 patients (58.5%) died during the hospitalization. Both the estimated probability of death and the in-hospital mortality rates of the three groups represented U-curves. According to the Cox proportional hazard method, LG (hazard ratio, 1.527; 95% confidence interval, 1.152-2.024; P = 0.003, compared with IG group), age (1.014; 1.006-1.021), diabetes (1.279; 1.022-1.601; P = 0.031), cirrhosis (2.147; 1.421-3.242), extracorporeal membrane oxygenation support (1.811; 1.391-2.359), initial neurological dysfunction (1.448; 1.107-1.894; P = 0.007), pre-RRT mean arterial pressure (0.988; 0.981-0.995), inotropic equivalent (1.006; 1.001-1.012; P = 0.013), APACHE II scores (1.055; 1.037-1.073), and sepsis (1.939; 1.536-2.449) were independent predictors of the in-hospital mortality (All P<0.001 except otherwise stated).
The current study found a U-curve association between the timing of the RRT initiation after the ICU admission and patients' in-hospital mortalities, and alerts physicians of certain factors affecting the outcome after the RRT initiation.
术后急性肾损伤（AKI）与手术患者的不良预后相关。本研究旨在评估肾脏替代治疗（RRT）开始的时机是否影响术后 AKI 患者的住院死亡率。
这是一项多中心回顾性观察性研究，在台湾国立台湾大学医院及其分院的重症监护病房（ICU）进行，时间为 2002 年 1 月至 2009 年 4 月。纳入术后 AKI 并因预设指征接受 RRT 的成年患者。记录患者的人口统计学数据、合并症、手术类型和 RRT 以及 RRT 的指征。根据 ICU 入院和 RRT 开始之间的时间间隔将患者分为早期（EG，≦1 天）、中期（IG，2-3 天）和晚期（LG，≧4 天）组。以 180 天住院死亡率为终点。
共纳入 648 例患者（418 例男性，平均年龄 63.0±15.9 岁），379 例（58.5%）患者在住院期间死亡。三组的估计死亡率和住院死亡率均呈 U 形曲线。根据 Cox 比例风险模型，LG（风险比，1.527；95%置信区间，1.152-2.024；P=0.003，与 IG 组相比）、年龄（1.014；1.006-1.021）、糖尿病（1.279；1.022-1.601；P=0.031）、肝硬化（2.147；1.421-3.242）、体外膜氧合支持（1.811；1.391-2.359）、初始神经功能障碍（1.448；1.107-1.894；P=0.007）、预 RRT 平均动脉压（0.988；0.981-0.995）、正性肌力等效物（1.006；1.001-1.012；P=0.013）、APACHE II 评分（1.055；1.037-1.073）和脓毒症（1.939；1.536-2.449）是住院死亡率的独立预测因素（除另有说明外，所有 P<0.001）。
本研究发现 ICU 入院后 RRT 开始时间与患者住院死亡率之间呈 U 形关联，并提醒医生注意 RRT 开始后影响结局的某些因素。
