Srisawat Nattachai, Sileanu Florentina E, Murugan Raghavan, Bellomod Rinaldo, Calzavacca Paolo, Cartin-Ceba Rodrigo, Cruz Dinna, Finn Judith, Hoste Eric E J, Kashani Kianoush, Ronco Claudio, Webb Steve, Kellum John A
The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa., USA.
Am J Nephrol. 2015;41(1):81-8. doi: 10.1159/000371748. Epub 2015 Feb 10.
Despite standardized definitions of acute kidney injury (AKI), there is wide variation in the reported rates of AKI and hospital mortality for patients with AKI. Variation could be due to actual differences in disease incidence, clinical course, or a function of data ascertainment and application of diagnostic criteria. Using standard criteria may help determine and compare the risk and outcomes of AKI across centers.
In this cohort study of critically ill patients admitted to the intensive care units at six hospitals in four countries, we used KDIGO criteria to define AKI. The main outcomes were the occurrence of AKI and hospital mortality.
Of the 15,132 critically ill patients, 32% developed AKI based on serum creatinine criteria. After adjusting for differences in age, sex, and severity of illness, the odds ratio for AKI continued to vary across centers (odds ratio (OR), 2.57-6.04, p < 0.001). The overall, crude hospital mortality of patients with AKI was 27%, which also varied across centers after adjusting for KDIGO stage, differences in age, sex, and severity of illness (OR, 1.13-2.20, p < 0.001). The severity of AKI was associated with incremental mortality risk across centers.
In this study, the absolute and severity-adjusted rates of AKI and hospital mortality rates for AKI varied across centers. Future studies should examine whether variation in the risk of AKI among centers is due to differences in clinical practice or process of care or residual confounding due to unmeasured factors.
尽管急性肾损伤（AKI）有标准化定义，但AKI的报告发生率及AKI患者的医院死亡率仍存在很大差异。这种差异可能是由于疾病发病率、临床病程的实际差异，或者是数据确定及诊断标准应用的作用。使用标准标准可能有助于确定和比较各中心AKI的风险及结局。
在这项对四个国家六家医院重症监护病房收治的重症患者的队列研究中，我们使用KDIGO标准来定义AKI。主要结局为AKI的发生及医院死亡率。
在15132例重症患者中，32%根据血清肌酐标准发生了AKI。在调整年龄、性别及疾病严重程度差异后，各中心AKI的比值比仍存在差异（比值比（OR），2.57 - 6.04，p < 0.001）。AKI患者的总体粗医院死亡率为27%，在调整KDIGO分期、年龄、性别及疾病严重程度差异后，各中心之间也存在差异（OR，1.13 - 2.20，p < 0.00）。AKI的严重程度与各中心的死亡风险增加相关。
在本研究中，各中心AKI的绝对发生率、严重程度调整后的发生率及AKI的医院死亡率均存在差异。未来研究应探讨各中心AKI风险的差异是由于临床实践或护理过程的不同，还是由于未测量因素导致的残余混杂。
