Vandenberghe Wim, Gevaert Sofie, Kellum John A, Bagshaw Sean M, Peperstraete Harlinde, Herck Ingrid, Decruyenaere Johan, Hoste Eric A J
Departments of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium.
Departments of Cardiology, Ghent University Hospital, Ghent University, Ghent, Belgium.
Cardiorenal Med. 2016 Feb;6(2):116-28. doi: 10.1159/000442300. Epub 2015 Dec 19.
We evaluated the epidemiology and outcome of acute kidney injury (AKI) in patients with cardiorenal syndrome type 1 (CRS-1) and its subgroups: acute heart failure (AHF), acute coronary syndrome (ACS) and after cardiac surgery (CS).
We performed a systematic review and meta-analysis. CRS-1 was defined by AKI (based on RIFLE, AKIN and KDIGO), worsening renal failure (WRF) and renal replacement therapy (RRT). We investigated the three most common clinical causes of CRS-1: AHF, ACS and CS. Out of 332 potential papers, 64 were eligible - with AKI used in 41 studies, WRF in 25 and RRT in 20. The occurrence rate of CRS-1, defined by AKI, WRF and RRT, was 25.4, 22.4 and 2.6%, respectively. AHF patients had a higher occurrence rate of CRS-1 compared to ACS and CS patients (AKI: 47.4 vs. 14.9 vs. 22.1%), but RRT was evenly distributed among the types of acute cardiac disease. AKI was associated with an increased mortality rate (risk ratio = 5.14, 95% CI 3.81-6.94; 24 studies and 35,227 patients), a longer length of stay in the intensive care unit [LOSICU] (median duration = 1.37 days, 95% CI 0.41-2.33; 9 studies and 10,758 patients) and a longer LOS in hospital [LOShosp] (median duration = 3.94 days, 95% CI 1.74-6.15; 8 studies and 35,227 patients). Increasing AKI severity was associated with worse outcomes. The impact of CRS-1 defined by AKI on mortality was greatest in CS patients. RRT had an even greater impact compared to AKI (mortality risk ratio = 9.2, median duration of LOSICU = 10.6 days and that of LOShosp = 20.2 days).
Of all included patients, almost one quarter developed AKI and approximately 3% needed RRT. AHF patients experienced the highest occurrence rate of AKI, but the impact on mortality was greatest in CS patients.
我们评估了1型心肾综合征（CRS-1）患者及其亚组（急性心力衰竭（AHF）、急性冠状动脉综合征（ACS）和心脏手术后（CS））中急性肾损伤（AKI）的流行病学及预后情况。
我们进行了一项系统评价和荟萃分析。CRS-1通过AKI（基于RIFLE、AKIN和KDIGO标准）、肾功能恶化（WRF）和肾脏替代治疗（RRT）来定义。我们调查了CRS-1的三种最常见临床病因：AHF、ACS和CS。在332篇潜在论文中，64篇符合条件——41项研究使用了AKI，25项使用了WRF，20项使用了RRT。由AKI、WRF和RRT定义的CRS-1发生率分别为25.4%、22.4%和2.6%。与ACS和CS患者相比，AHF患者的CRS-1发生率更高（AKI：47.4% 对14.9% 对22.1%），但RRT在各类急性心脏疾病中分布均匀。AKI与死亡率增加相关（风险比 = 5.14，95%可信区间3.81 - 6.94；24项研究，35227例患者），在重症监护病房（ICU）的住院时间更长[LOSICU]（中位持续时间 = 1.37天，95%可信区间0.41 - 2.33；9项研究，10758例患者），在医院的住院时间更长[LOShosp]（中位持续时间 = 3.94天，95%可信区间1.74 - 6.15；8项研究，35227例患者）。AKI严重程度增加与更差的预后相关。由AKI定义的CRS-1对死亡率的影响在CS患者中最大。与AKI相比，RRT的影响更大（死亡风险比 = 9.2，LOSICU中位持续时间 = 10.6天，LOShosp中位持续时间 = 20.2天）。
在所有纳入患者中，近四分之一发生了AKI，约3%需要RRT。AHF患者的AKI发生率最高，但对死亡率的影响在CS患者中最大。
