社区获得性与医院获得性 AKI 的流行病学和结局。
Epidemiology and outcomes in community-acquired versus hospital-acquired AKI.
机构信息
Institute of Nephrology, University Hospital of Wales, Cardiff, United Kingdom.
Institute of Nephrology, University Hospital of Wales, Cardiff, United Kingdom
出版信息
Clin J Am Soc Nephrol. 2014 Jun 6;9(6):1007-14. doi: 10.2215/CJN.07920713. Epub 2014 Mar 27.
BACKGROUND AND OBJECTIVE
Compared with AKI in hospitalized patients, little is known about patients sustaining AKI in the community and how this differs from AKI in hospital. This study compared epidemiology, risk factors, and short- and long-term outcomes for patients with community-acquired (CA) and hospital-acquired (HA) AKI.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A total of 15,976 patients admitted to two district general hospitals between July 11, 2011, and January 15, 2012 were studied. Through use of an electronic database and the AKI Network classification, 686 patients with CA-AKI and 334 patients with HA-AKI were identified. Patients were followed up for 14 months, and data were collated on short-term and long-term renal and patient outcomes.
RESULTS
The incidence of CA-AKI among all hospital admissions was 4.3% compared with an incidence of 2.1% of HA-AKI, giving an overall AKI incidence of 6.4%. Patients with CA-AKI were younger than patients with HA-AKI. Risks for developing HA and CA-AKI were similar and included preexisting CKD, cardiac failure, ischemic heart disease, hypertension, diabetes, dementia, and cancer. Patients with CA-AKI were more likely to have stage 3 AKI and had shorter lengths of hospital stay than patients with HA-AKI. Those with CA-AKI had better (multivariate-adjusted) survival than patients with HA-AKI (hazard ratio, 1.8 [95% CI, 1.44-2.13; P<0.001] for HA-AKI group). Mortality for the CA-AKI group was 45%; 43.7% of these deaths were acute in-hospital deaths. Mortality for the HA-AKI group was 62.9%, with 68.1% of these deaths being acute in-hospital deaths. Renal referral rates were low across the cohorts (8.3%). Renal outcomes were similar in both CA-AKI and HA-AKI groups, with 39.4% and 33.6% of patients in both groups developing de novo CKD or progression of preexisting CKD within 14 months, respectively.
CONCLUSION
Patients with CA-AKI sustain more severe AKI than patients with HA-AKI. Despite having risk factors similar to those of patients with HA-AKI, patients with CA AKI have better short- and long-term outcomes.
背景与目的
相较于住院患者的急性肾损伤（AKI），社区获得性 AKI（CA-AKI）患者的情况鲜为人知，且 CA-AKI 与医院获得性 AKI（HA-AKI）之间的差异也尚不明确。本研究旨在比较 CA-AKI 和 HA-AKI 患者的流行病学、风险因素以及短期和长期结局。
设计、地点、参与者和测量：对 2011 年 7 月 11 日至 2012 年 1 月 15 日期间在两家地区综合医院住院的 15976 例患者进行了研究。通过使用电子数据库和 AKI 网络分类，确定了 686 例 CA-AKI 患者和 334 例 HA-AKI 患者。对患者进行了 14 个月的随访，对短期和长期肾脏及患者结局数据进行了整理。
结果
所有住院患者中 CA-AKI 的发生率为 4.3%，而 HA-AKI 的发生率为 2.1%，总 AKI 发生率为 6.4%。与 HA-AKI 患者相比，CA-AKI 患者更年轻。发生 HA 和 CA-AKI 的风险因素相似，包括慢性肾脏病（CKD）前期、心力衰竭、缺血性心脏病、高血压、糖尿病、痴呆和癌症。CA-AKI 患者更有可能处于 AKI 3 期，且住院时间短于 HA-AKI 患者。与 HA-AKI 患者相比，CA-AKI 患者的（多变量校正后）生存率更好（HA-AKI 组的危险比为 1.8[95%CI，1.44-2.13；P<0.001]）。CA-AKI 组的死亡率为 45%；其中 43.7%的死亡为急性院内死亡。HA-AKI 组的死亡率为 62.9%，其中 68.1%的死亡为急性院内死亡。两组的肾脏转诊率均较低（8.3%）。CA-AKI 和 HA-AKI 两组的肾脏结局相似，两组分别有 39.4%和 33.6%的患者在 14 个月内新发慢性肾脏病或原有 CKD 进展。
结论
与 HA-AKI 患者相比，CA-AKI 患者的 AKI 更严重。尽管 CA-AKI 患者与 HA-AKI 患者的风险因素相似，但 CA-AKI 患者的短期和长期结局更好。
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