接受肾脏替代治疗的急性肾损伤重症患者的长期生活质量：一项匹配队列研究。
Long-term quality of life in critically ill patients with acute kidney injury treated with renal replacement therapy: a matched cohort study.
作者信息
Oeyen Sandra, De Corte Wouter, Benoit Dominique, Annemans Lieven, Dhondt Annemieke, Vanholder Raymond, Decruyenaere Johan, Hoste Eric
机构信息
Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
出版信息
Crit Care. 2015 Aug 6;19(1):289. doi: 10.1186/s13054-015-1004-8.
INTRODUCTION
Acute kidney injury (AKI) is a common complication in intensive care unit (ICU) patients and is associated with increased morbidity and mortality. We compared long-term outcome and quality of life (QOL) in ICU patients with AKI treated with renal replacement therapy (RRT) with matched non-AKI-RRT patients.
METHODS
Over 1 year, consecutive adult ICU patients were included in a prospective cohort study. AKI-RRT patients alive at 1 year and 4 years were matched with non-AKI-RRT survivors from the same cohort in a 1:2 (1 year) and 1:1 (4 years) ratio based on gender, age, Acute Physiology and Chronic Health Evaluation II score, and admission category. QOL was assessed by the EuroQoL-5D and the Short Form-36 survey before ICU admission and at 3 months, 1 and 4 years after ICU discharge.
RESULTS
Of 1953 patients, 121 (6.2%) had AKI-RRT. AKI-RRT hospital survivors (44.6%; N = 54) had a 1-year and 4-year survival rate of 87.0% (N = 47) and 64.8% (N = 35), respectively. Forty-seven 1-year AKI-RRT patients were matched with 94 1-year non-AKI-RRT patients. Of 35 4-year survivors, three refused further cooperation, three were lost to follow-up, and one had no control. Finally, 28 4-year AKI-RRT patients were matched with 28 non-AKI-RRT patients. During ICU stay, 1-year and 4-year AKI-RRT patients had more organ dysfunction compared to their respective matches (Sequential Organ Failure Assessment scores 7 versus 5, P < 0.001, and 7 versus 4, P < 0.001). Long-term QOL was, however, comparable between both groups but lower than in the general population. QOL decreased at 3 months, improved after 1 and 4 years but remained under baseline level. One and 4 years after ICU discharge, 19.1% and 28.6% of AKI-RRT survivors remained RRT-dependent, respectively, and 81.8% and 71% of them were willing to undergo ICU admission again if needed.
CONCLUSION
In long-term critically ill AKI-RRT survivors, QOL was comparable to matched long-term critically ill non-AKI-RRT survivors, but lower than in the general population. The majority of AKI-RRT patients wanted to be readmitted to the ICU when needed, despite a higher severity of illness compared to matched non-AKI-RRT patients, and despite the fact that one quarter had persistent dialysis dependency.
引言
急性肾损伤（AKI）是重症监护病房（ICU）患者常见的并发症，与发病率和死亡率增加相关。我们比较了接受肾脏替代治疗（RRT）的AKI ICU患者与匹配的非AKI-RRT患者的长期结局和生活质量（QOL）。
方法
在1年多的时间里，连续纳入成年ICU患者进行前瞻性队列研究。根据性别、年龄、急性生理与慢性健康状况评分II（APACHE II）和入院类别，将1年和4年存活的AKI-RRT患者与同一队列中的非AKI-RRT幸存者按1:2（1年）和1:1（4年）的比例进行匹配。在ICU入院前、出院后3个月、1年和4年时，通过欧洲五维健康量表（EuroQoL-5D）和简明健康调查问卷（Short Form-36）评估生活质量。
结果
1953例患者中，121例（6.2%）接受了AKI-RRT治疗。AKI-RRT医院幸存者（44.6%；N = 54）的1年和4年生存率分别为87.0%（N = 47）和64.8%（N = 35）。47例1年AKI-RRT患者与94例1年非AKI-RRT患者匹配。35例4年幸存者中，3例拒绝进一步合作，3例失访，1例未进行对照。最终，28例4年AKI-RRT患者与28例非AKI-RRT患者匹配。在ICU住院期间，1年和4年AKI-RRT患者相比各自的匹配对象有更多器官功能障碍（序贯器官衰竭评估评分分别为7比5，P < 0.001；7比4，P < 0.001）。然而，两组的长期生活质量相当，但低于一般人群。生活质量在3个月时下降，1年和4年后有所改善，但仍低于基线水平。ICU出院后1年和4年，分别有19.1%和28.6%的AKI-RRT幸存者仍依赖RRT，其中81.8%和71%表示如有需要愿意再次入住ICU。
结论
在长期危重症AKI-RRT幸存者中，生活质量与匹配的长期危重症非AKI-RRT幸存者相当，但低于一般人群。尽管与匹配的非AKI-RRT患者相比病情更严重，且四分之一的患者持续依赖透析，但大多数AKI-RRT患者如有需要仍希望再次入住ICU。
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