Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China.
Chin Med J (Engl). 2013 Dec;126(23):4409-16.
Acute kidney injury (AKI) has been recognized as a major healthcare problem affecting millions of patients worldwide. However, epidemiologic data concerning AKI in China are still lacking. The objectives of this study were to characterize AKI defined by RIFLE criteria, assess the association with hospital mortality, and evaluate the impact of AKI in the context of other risk factors.
This prospective multicenter observational study enrolled 3,063 consecutive patients from 1 July 2009 to 31 August 2009 in 22 ICUs across mainland China. We excluded patients who were admitted for less than 24 hours (n = 1623), younger than 18 years (n = 127), receiving chronic hemodialysis (n = 29), receiving renal transplantation (n = 1) and unknown reasons (n = 28). There were 1255 patients in the final analysis. AKI was diagnosed and classified according to RIFLE criteria.
There were 396 patients (31.6%) who had AKI, with RIFLE maximum class R, I, and F in 126 (10.0%), 91 (7.3%), and 179 (14.3%) patients, respectively. Renal function deteriorated in 206 patients (16.4%). In comparison with non AKI patients, patients in the risk class on ICU admission were more likely to progress to the injury class (odds ratio (OR) 3.564, 95% confidence interval (CI) 1.706 - 7.443, P = 0.001], while patients in the risk class (OR 5.215, 95% CI 2.798-9.719, P < 0.001) and injury class (OR 13.316, 95% CI 7.507-23.622, P < 0.001) had a significantly higher probability of deteriorating into failure class. The adjusted hazard ratios for 90-day mortality were 1.884 for the risk group, 3.401 for the injury group, and 5.306 for the failure group.
The prevalence of AKI was high among critically ill patients in Chinese ICUs. In comparison with non-AKI patients, patients with RIFLE class R or class I on ICU admission were more susceptibility to progression to class I or class F. The RIFLE criteria were robust and correlated well with clinical deterioration and mortality.
急性肾损伤（AKI）已被确认为影响全球数以百万计患者的主要医疗保健问题。然而，关于中国 AKI 的流行病学数据仍然缺乏。本研究的目的是描述 RIFLE 标准定义的 AKI，评估其与医院死亡率的相关性，并评估 AKI 在其他危险因素背景下的影响。
本前瞻性多中心观察性研究纳入了 2009 年 7 月 1 日至 8 月 31 日期间中国大陆 22 个 ICU 的 3063 例连续患者。我们排除了入住时间少于 24 小时的患者（n=1623）、年龄小于 18 岁的患者（n=127）、接受慢性血液透析的患者（n=29）、接受肾移植的患者（n=1）和原因不明的患者（n=28）。最终有 1255 例患者进行了分析。根据 RIFLE 标准诊断和分类 AKI。
有 396 例（31.6%）患者发生 AKI，其中 RIFLE 最大类别 R、I 和 F 分别为 126 例（10.0%）、91 例（7.3%）和 179 例（14.3%）。206 例（16.4%）患者肾功能恶化。与非 AKI 患者相比，入住 ICU 时处于风险类别的患者更有可能进展为损伤类（优势比[OR]3.564，95%置信区间[CI]1.706-7.443，P=0.001），而处于风险类（OR 5.215，95%CI 2.798-9.719，P<0.001）和损伤类（OR 13.316，95%CI 7.507-23.622，P<0.001）的患者肾功能恶化到衰竭类的可能性显著增加。90 天死亡率的调整危险比分别为风险组 1.884，损伤组 3.401，衰竭组 5.306。
中国 ICU 危重症患者 AKI 的患病率较高。与非 AKI 患者相比，入住 ICU 时 RIFLE 类别 R 或 I 的患者更易进展为类别 I 或 F。RIFLE 标准是可靠的，与临床恶化和死亡率密切相关。
