Research and Medical Service, Veterans Affairs Medical Center, Washington, DC;, †Division of Renal Diseases and Hypertension, Department of Medicine, and, ‡Department of Anesthesiology and Critical Care Medicine, George Washington University, Washington, DC;, §Departments of Psychiatry and Surgery, Georgetown University School of Medicine, Washington, DC;, ‖Department of Anesthesiology, Duke University Medical Center and Veterans Affairs Medical Center, Durham, North Carolina, ¶National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
Clin J Am Soc Nephrol. 2014 Mar;9(3):448-56. doi: 10.2215/CJN.02440213. Epub 2013 Dec 5.
AKI is associated with major adverse kidney events (MAKE): death, new dialysis, and worsened renal function. CKD (arising from worsened renal function) is associated with a higher risk of major adverse cardiac events (MACE): myocardial infarction (MI), stroke, and heart failure. Therefore, the study hypothesis was that veterans who develop AKI during hospitalization for an MI would be at higher risk of subsequent MACE and MAKE.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients in the Veterans Affairs (VA) database who had a discharge diagnosis with International Classification of Diseases, Ninth Revision, code of 584.xx (AKI) or 410.xx (MI) and were admitted to a VA facility from October 1999 through December 2005 were selected for analysis. Three groups of patients were created on the basis of the index admission diagnosis and serum creatinine values: AKI, MI, or MI with AKI. Patients with mean baseline estimated GFR<45 ml/min per 1.73 m(2) were excluded. The primary outcomes assessed were mortality, MAKE, and MACE during the study period (maximum of 6 years). The combination of MAKE and MACE-major adverse renocardiovascular events (MARCE)-was also assessed.
A total of 36,980 patients were available for analysis. Mean age±SD was 66.8±11.4 years. The most deaths occurred in the MI+AKI group (57.5%), and the fewest (32.3%) occurred in patients with an uncomplicated MI admission. In both the unadjusted and adjusted time-to-event analyses, patients with AKI and AKI+MI had worse MARCE outcomes than those who had MI alone (adjusted hazard ratios, 1.37 [95% confidence interval, 1.32 to 1.42] and 1.92 [1.86 to 1.99], respectively).
Veterans who develop AKI in the setting of MI have worse long-term outcomes than those with AKI or MI alone. Veterans with AKI alone have worse outcomes than those diagnosed with an MI in the absence of AKI.
急性肾损伤（AKI）与主要不良肾脏事件（MAKE）相关：死亡、新透析和肾功能恶化。慢性肾脏病（由肾功能恶化引起）与主要不良心脏事件（MACE）的风险增加相关：心肌梗死（MI）、中风和心力衰竭。因此，研究假设是，在因 MI 住院期间发生 AKI 的退伍军人随后发生 MACE 和 MAKE 的风险更高。
设计、地点、参与者和测量：从 1999 年 10 月至 2005 年 12 月，从退伍军人事务部（VA）数据库中选择了出院诊断为国际疾病分类，第 9 修订版代码 584.xx（AKI）或 410.xx（MI）并入住 VA 设施的患者进行分析。根据入院时的诊断和血清肌酐值，将患者分为三组：AKI、MI 或 MI+AKI。排除了基线估计肾小球滤过率（eGFR）<45 ml/min/1.73 m2 的患者。研究期间评估的主要结局是死亡率、MAKE 和 MACE（最长 6 年）。还评估了 MAKE 和 MACE-主要不良肾心事件（MARCE）的组合。
共有 36980 名患者可用于分析。平均年龄±标准差为 66.8±11.4 岁。MI+AKI 组的死亡率最高（57.5%），而单纯 MI 组的死亡率最低（32.3%）。在未调整和调整后的时间事件分析中，与单独 MI 相比，AKI 和 AKI+MI 患者的 MARCE 结局更差（调整后的风险比，1.37 [95%置信区间，1.32 至 1.42]和 1.92 [1.86 至 1.99]）。
在 MI 背景下发生 AKI 的退伍军人的长期预后比单独发生 AKI 或 MI 的退伍军人更差。单独发生 AKI 的退伍军人比没有 AKI 而诊断为 MI 的退伍军人的预后更差。
