住院患者急性肾损伤不同定义的发病率、结局及比较。
Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals.
作者信息
Zeng Xiaoxi, McMahon Gearoid M, Brunelli Steven M, Bates David W, Waikar Sushrut S
机构信息
Renal Division and , ‡General Internal Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts;, †Department of Nephrology, West China Hospital of Sichuan University, Sichuan, People's Republic of China, §Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts.
出版信息
Clin J Am Soc Nephrol. 2014 Jan;9(1):12-20. doi: 10.2215/CJN.02730313. Epub 2013 Oct 31.
BACKGROUND AND OBJECTIVES
At least four definitions of AKI have recently been proposed. This study sought to characterize the epidemiology of AKI according to the most recent consensus definition proposed by the Kidney Disease Improving Global Outcomes (KDIGO) Work Group, and to compare it with three other definitions.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a retrospective cohort study of 31,970 hospitalizations at an academic medical center in 2010. AKI was defined and staged according to KDIGO criteria, the Acute Dialysis Quality Initiative's RIFLE criteria, the Acute Kidney Injury Network (AKIN) criteria, and a definition based on a model of creatinine kinetics (CK). Outcomes of interest were incidence, in-hospital mortality, length of stay, costs, readmission rates, and posthospitalization disposition.
RESULTS
AKI incidence was highest according to the KDIGO definition (18.3%) followed by the AKIN (16.6%), RIFLE (16.1%), and CK (7.0%) definitions. AKI incidence appeared markedly higher in those with low baseline serum creatinine according to the KDIGO, AKIN, and RIFLE definitions, in which AKI may be defined by a 50% increase over baseline. AKI according to all definitions was associated with a significantly higher risk of death and higher resource utilization. The adjusted odds ratios for in-hospital mortality in those with AKI were highest with the CK definition (5.2; 95% confidence interval [95% CI], 4.1 to 6.6), followed by the RIFLE (2.9; 95% CI, 2.2 to 3.6), KDIGO (2.8; 95% CI, 2.2 to 3.6), and AKIN (2.6; 95% CI, 2.0 to 3.3) definitions. Concordance in diagnosis and staging was high among the KDIGO, AKIN, and RIFLE definitions.
CONCLUSIONS
The incidence of AKI in hospitalized individuals varies depending on the definition used. AKI according to all definitions is associated with higher in-hospital mortality and resource utilization. AKI may be inappropriately diagnosed in those with low baseline serum creatinine using definitions that incorporate percentage increases over baseline.
背景与目的
最近至少提出了四种急性肾损伤（AKI）的定义。本研究旨在根据改善全球肾脏病预后（KDIGO）工作组提出的最新共识定义来描述AKI的流行病学特征，并将其与其他三种定义进行比较。
设计、地点、参与者及测量方法：这是一项对2010年在一家学术医疗中心的31970例住院病例进行的回顾性队列研究。根据KDIGO标准、急性透析质量倡议组织的RIFLE标准、急性肾损伤网络（AKIN）标准以及基于肌酐动力学模型（CK）的定义对AKI进行定义和分期。感兴趣的结局包括发病率、住院死亡率、住院时间、费用、再入院率以及出院后去向。
结果
根据KDIGO定义，AKI发病率最高（18.3%），其次是AKIN（16.6%）、RIFLE（16.1%）和CK（7.0%）定义。根据KDIGO、AKIN和RIFLE定义，基线血清肌酐水平较低者的AKI发病率明显更高，在这些定义中，AKI可定义为较基线水平升高50%。所有定义的AKI均与显著更高的死亡风险和更高的资源利用相关。AKI患者住院死亡率的校正比值比以CK定义最高（5.2；95%置信区间[95%CI]，4.1至6.6），其次是RIFLE（2.9；95%CI，2.2至3.6）、KDIGO（2.8；95%CI，2.2至3.6）和AKIN（2.6；95%CI，2.0至3.3）定义。KDIGO、AKIN和RIFLE定义在诊断和分期方面的一致性较高。
结论
住院患者中AKI的发病率因所使用的定义而异。所有定义的AKI均与更高的住院死亡率和资源利用相关。使用纳入较基线水平升高百分比的定义，可能会对基线血清肌酐水平较低者进行不恰当的AKI诊断。
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