急性肾损伤的归因死亡率：序贯匹配分析*。

The attributable mortality of acute kidney injury: a sequentially matched analysis*.

机构信息

1Intensive Care Units, Division of Anaesthesia and Intensive Care Medicine, Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland. 2Department of Clinical Sciences, University of Helsinki, Helsinki, Finland. 3ANZIC Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. 4Division of Intensive Care, Kuopio University Hospital, Kuopio, Finland. 5Department of Intensive Care, North Karelia Central Hospital, Joensuu, Finland.

出版信息

Crit Care Med. 2014 Apr;42(4):878-85. doi: 10.1097/CCM.0000000000000045.

DOI:10.1097/CCM.0000000000000045

PMID:24201174

Abstract

OBJECTIVE

Acute kidney injury in the critically ill is an independent risk factor for adverse outcome. The magnitude of the impact of acute kidney injury on outcome, however, is still unclear. This study aimed to estimate the excess mortality attributable to acute kidney injury.

DESIGN

We performed a sequentially matched analysis according to the day of acute kidney injury diagnosis after ICU admission. Patients with acute kidney injury and those without acute kidney injury were matched according to age, sex, ICU admission diagnosis, Simplified Acute Physiology Score II without renal and age components, and the propensity to develop acute kidney injury at each of the four matching time points.

SETTING

Cohort of 16 participating ICUs from the prospective Finnish Acute Kidney Injury study.

PATIENTS

Cohort of 2,719 consecutive patients with either emergency admission or elective postsurgical patients with an expected ICU stay greater than 24 hours.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Of the 2,719 patients included in the study, acute kidney injury developed in 1,081 patients (39.8%) according to the Kidney Disease: Improving Global Outcomes-definition during ICU treatment on days 1-5. Of these, 477 patients were successfully matched to 477 patients who did not develop acute kidney injury. The 90-day mortality of the matched patients with acute kidney injury was 125 of 477 (26.2%) compared with 84 of 477 (17.6%) for their matched controls without acute kidney injury. Thus, the absolute excess 90-day mortality attributable to acute kidney injury was estimated at 8.6 percentage points (95% CI, 2.6-17.6 percentage points). The population attributable risk (95% CI) of 90-day mortality associated with acute kidney injury was 19.6% (10.3-34.1%).

CONCLUSIONS

In general ICU patients, the absolute excess 90-day mortality statistically attributable to acute kidney injury is substantial (8.6%), and the population attributable risk was nearly 20%. Our findings are useful in planning suitably powered future clinical trials to prevent and treat acute kidney injury in critically ill patients.

摘要

目的

危重症患者的急性肾损伤是不良预后的独立危险因素。然而，急性肾损伤对预后的影响程度仍不清楚。本研究旨在评估急性肾损伤导致的超额死亡率。

设计

我们根据 ICU 入住后急性肾损伤诊断的天数进行了连续匹配分析。患有急性肾损伤和未患有急性肾损伤的患者根据年龄、性别、ICU 入院诊断、不包括肾脏和年龄成分的简化急性生理学评分 II 以及在四个匹配时间点中每个时间点发生急性肾损伤的倾向进行匹配。

地点

前瞻性芬兰急性肾损伤研究的 16 个参与 ICU 的队列。

患者

连续 2719 例急症入院或预计 ICU 住院时间超过 24 小时的择期手术后患者。

干预措施

无。

测量和主要结果

在研究中纳入的 2719 例患者中，根据 ICU 治疗第 1-5 天的肾脏疾病：改善全球结局定义，有 1081 例（39.8%）发生急性肾损伤。其中，477 例患者成功匹配了 477 例未发生急性肾损伤的患者。患有急性肾损伤的匹配患者的 90 天死亡率为 477 例中的 125 例（26.2%），而其未发生急性肾损伤的匹配对照组为 477 例中的 84 例（17.6%）。因此，估计 90 天死亡率归因于急性肾损伤的绝对超额为 8.6%（95%CI，2.6-17.6%）。与急性肾损伤相关的 90 天死亡率的人群归因风险（95%CI）为 19.6%（10.3-34.1%）。