Singh T B, Rathore S S, Choudhury T A, Shukla V K, Singh D K, Prakash J
Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Indian J Nephrol. 2013 Jan;23(1):24-9. doi: 10.4103/0971-4065.107192.
Acute kidney injury (AKI) is a common complication in hospitalized patients. There are few comparative studies on hospital-acquired AKI (HAAKI) in medical, surgical, and ICU patients. This study was conducted to compare the epidemiological characteristics, clinical profiles, and outcomes of HAAKI among these three units. All adult patients (>18 years) of either gender who developed AKI based on RIFLE criteria (using serum creatinine), 48 h after hospitalization were included in the study. Patients of acute on chronic renal failure and AKI in pregnancy were excluded. Incidence of HAAKI in medical, surgical, and ICU wards were 0.54%, 0.72%, and 2.2% respectively (P < 0.0001). There was no difference in age distribution among the groups, but onset of HAAKI was earliest in the medical ward (P = 0.001). RIFLE-R was the most common AKI in medical (39.2%) and ICU (50%) wards but in the surgical ward, it was RIFLE-F that was most common (52.6%). Acute tubular necrosis was more common in ICU (P = 0.043). Most common etiology of HAAKI in medical unit was drug induced (39.2%), whereas in surgical and ICU, it was sepsis (34% and 35.2% respectively). Mortality in ICU, surgical and medical units were 73.5%, 43.42%, and 37.2%, respectively (P = 0.003). Length of hospital stay in surgical, ICU and medical units were different (P = 0.007). This study highlights that the characters of HAAKI are different in some aspects among different hospital settings.
急性肾损伤（AKI）是住院患者常见的并发症。关于内科、外科和重症监护病房（ICU）患者医院获得性急性肾损伤（HAAKI）的比较研究较少。本研究旨在比较这三个科室中HAAKI的流行病学特征、临床概况及转归。本研究纳入所有住院48小时后根据RIFLE标准（采用血清肌酐）发生AKI的成年患者（年龄>18岁），性别不限。排除急性慢性肾衰竭患者及妊娠合并AKI患者。内科、外科和ICU病房的HAAKI发生率分别为0.54%、0.72%和2.2%（P<0.0001）。各组间年龄分布无差异，但HAAKI在内科病房发病最早（P=0.001）。RIFLE-R是内科（39.2%）和ICU病房（50%）最常见的AKI类型，但在外科病房，最常见的是RIFLE-F（52.6%）。急性肾小管坏死在ICU更常见（P=0.043）。内科病房HAAKI最常见的病因是药物性（39.2%），而在外科和ICU，病因是脓毒症（分别为34%和35.2%）。ICU、外科和内科病房的死亡率分别为73.5%、43.42%和37.2%（P=0.003）。外科、ICU和内科病房的住院时间不同（P=0.007）。本研究强调，不同医院环境下HAAKI的特征在某些方面存在差异。
