Peres Luis Alberto Batista, Wandeur Vanessa, Matsuo Tiemi
Universidade Estadual do Oeste do Paraná, Brasil.
Faculdade Assis Gurgacz, Brasil.
J Bras Nefrol. 2015 Jan-Mar;37(1):38-46. doi: 10.5935/0101-2800.20150007.
To compare clinical characteristics and outcomes of patients with and without acute kidney injury (AKI), to evaluate the incidence and mortality of AKI and predictors of AKI and death in patients hospitalized in an Intensive Care Unit (ICU).
A retrospective study analyzed 152 patients admitted to a single ICU. We assessed age, gender, reason for hospitalization, risk factors for ARF, laboratory data, the need for renal therapy substitutive and mortality. Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA) and RIFLE were recorded on the day of ICU admission. We determined the incidence of AKI, mortality and the independent predictors of AKI and death using logistic regression model.
Mean age was 57.1 ± 20 years, ranging between 19 to 88 years, and 60.1% were male. Non-dialysis dependent AKI occurred in 81 patients (53.2%) while the ARF requiring dialysis occurred in 19 patients (12.4%). The overall mortality rate in the ICU was 35.9%, whereas the mortality rate in patients with non-dialysis dependent AKI was 43.2% and the IRA with dialysis of 84.2%. In multivariate analysis, invasive mechanical ventilation, elevated creatinine and urea at admission were independent risk factors for AKI, whereas clinical diagnosis, invasive mechanical ventilation, increased lactate and urea and hypernatremia were independent risk factors for ICU mortality.
The incidence and mortality of AKI in ICU were high in this study, despite the advances that have been emerging in their management.
比较有和没有急性肾损伤（AKI）患者的临床特征及预后，评估重症监护病房（ICU）住院患者中AKI的发病率、死亡率以及AKI和死亡的预测因素。
一项回顾性研究分析了入住单一ICU的152例患者。我们评估了年龄、性别、住院原因、急性肾衰竭的危险因素、实验室数据、肾脏替代治疗需求及死亡率。在入住ICU当天记录急性生理与慢性健康状况评分系统（APACHE II）、序贯器官衰竭评估（SOFA）和RIFLE分级。我们使用逻辑回归模型确定AKI的发病率、死亡率以及AKI和死亡的独立预测因素。
平均年龄为57.1±20岁，范围在19至88岁之间，男性占60.1%。81例患者（53.2%）发生非透析依赖型AKI，19例患者（12.4%）发生需要透析的急性肾衰竭。ICU的总体死亡率为35.9%，而非透析依赖型AKI患者的死亡率为43.2%，透析的急性肾衰竭患者死亡率为84.2%。多因素分析中，有创机械通气、入院时肌酐和尿素升高是AKI的独立危险因素，而临床诊断、有创机械通气、乳酸和尿素升高及高钠血症是ICU死亡的独立危险因素。
尽管在AKI管理方面有新进展，但本研究中ICU内AKI的发病率和死亡率仍很高。
