中国住院成人急性肾损伤的流行病学及临床关联
Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults.
作者信息
Xu Xin, Nie Sheng, Liu Zhangsuo, Chen Chunbo, Xu Gang, Zha Yan, Qian Jing, Liu Bicheng, Han Shuai, Xu Anping, Xu Xing, Hou Fan Fan
机构信息
National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China;
The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China;
出版信息
Clin J Am Soc Nephrol. 2015 Sep 4;10(9):1510-8. doi: 10.2215/CJN.02140215. Epub 2015 Jul 31.
BACKGROUND AND OBJECTIVES
Comprehensive epidemiologic data on AKI are particularly lacking in Asian countries. This study sought to assess the epidemiology and clinical correlates of AKI among hospitalized adults in China.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a multicenter retrospective cohort study of 659,945 hospitalized adults from a wide range of clinical settings in nine regional central hospitals across China in 2013. AKI was defined and staged according to Kidney Disease Improving Global Outcomes criteria. The incidence of AKI in the cohort was estimated using a novel two-step approach with adjustment for the frequency of serum creatinine tests and other potential confounders. Risk factor profiles for hospital-acquired (HA) and community-acquired (CA) AKI were examined. The in-hospital outcomes of AKI, including mortality, renal recovery, length of stay, and daily cost, were assessed.
RESULTS
The incidence of CA-AKI and HA-AKI was 2.5% and 9.1%, respectively, giving rise to an overall incidence of 11.6%. Although the risk profiles for CA-AKI and HA-AKI differed, preexisting CKD was a major risk factor for both, contributing to 20% of risk in CA-AKI and 12% of risk in HA-AKI. About 40% of AKI cases were possibly drug-related and 16% may have been induced by Chinese traditional medicines or remedies. The in-hospital mortality of AKI was 8.8%. The risk of in-hospital death was higher among patients with more severe AKI. Preexisting CKD and need for intensive care unit admission were associated with higher death risk in patients at any stage of AKI. Transiency of AKI did not modify the risk of in-hospital death. AKI was associated with longer length of stay and higher daily costs, even after adjustment for confounders.
CONCLUSION
AKI is common in hospitalized adults in China and is associated with significantly higher in-hospital mortality and resource utilization.
背景与目的
亚洲国家尤其缺乏关于急性肾损伤（AKI）的全面流行病学数据。本研究旨在评估中国住院成人中AKI的流行病学情况及其临床相关因素。
设计、地点、参与者及测量方法：这是一项多中心回顾性队列研究，研究对象为2013年来自中国9家区域中心医院各种临床科室的659945名住院成人。AKI根据改善全球肾脏病预后组织（KDIGO）标准进行定义和分期。采用一种新颖的两步法估计队列中AKI的发病率，并对血清肌酐检测频率及其他潜在混杂因素进行校正。研究医院获得性（HA）和社区获得性（CA）AKI的危险因素谱。评估AKI的院内结局，包括死亡率、肾功能恢复情况、住院时间及每日费用。
结果
CA-AKI和HA-AKI的发病率分别为2.5%和9.1%，总体发病率为11.6%。尽管CA-AKI和HA-AKI的危险因素谱有所不同，但既往存在的慢性肾脏病（CKD）是两者的主要危险因素，在CA-AKI中占风险的20%，在HA-AKI中占风险的12%。约40%的AKI病例可能与药物相关，16%可能由中药或传统疗法诱发。AKI的院内死亡率为8.8%。AKI病情越严重，患者的院内死亡风险越高。在AKI任何阶段的患者中，既往存在CKD及需要入住重症监护病房与更高的死亡风险相关。AKI的短暂性并未改变院内死亡风险。即使校正混杂因素后，AKI仍与更长的住院时间和更高的每日费用相关。
结论
AKI在中国住院成人中很常见，且与显著更高的院内死亡率及资源利用相关。
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