Baek Seon Ha, Lee Sung Woo, Kim Sun-Wook, Ahn Shin Young, Yu Mi-Yeon, Kim Kwang-Il, Chin Ho Jun, Na Ki Young, Chae Dong-Wan, Kim Sejoong
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
PLoS One. 2016 Jun 3;11(6):e0156444. doi: 10.1371/journal.pone.0156444. eCollection 2016.
Elderly patients have an increased risk for acute kidney injury (AKI). However, few studies have reported on predictors for AKI in geriatric patients. Therefore, we aimed at determining the effect of frailty as a predictor of AKI.
We retrospectively enrolled 533 hospitalized elderly patients (aged ≥ 65 years) who had their creatinine levels measured (≥ 1 measurement) during admission for a period of 1 year (2013) and conducted a comprehensive geriatric assessment (CGA) within 1 year before the index hospitalization. We examined five variables (activity of daily living [ADL] and instrumental ADL dependence, dementia, nutrition, and polypharmacy) from CGA. We categorized the patients into 3 groups according to the tertile of aggregate frailty scores: Group 1, score 1-2; Group 2, score 3-4; Group 3, score 5-8).
Fifty-four patients (10.1%) developed AKI (median duration, 4 days). The frailest group (Group 3) showed an increased risk of AKI as compared to Group 1, (hazard ratio [HR] = 3.536, P = 0.002). We found that discriminatory accuracy for AKI improved with the addition of the tertile of aggregate frailty score to covariates (area under the receiver operator characteristics curves [AUROC] 0.641, AUROC 0.739, P = 0.004). Forty-six patients (8.6%) were transferred to nursing facilities and 477 patients (89.5%) were discharged home. The overall 90-day and 1-year mortality for elderly inpatients were 7.9% and 26.3%. The frailest group also demonstrated an increased risk of discharge to nursing facilities, and 90-day and 1-year mortality as compared to Group 1, independent of AKI severity (nursing facilities: odd ratio = 4.843, P = 0.002; 90-day mortality: HR = 6.555, P = 0.002; 1-year mortality: HR = 3.249, P = 0.001).
We found that frailty may independently predict the development of AKI and adverse outcomes in geriatric inpatients.
老年患者急性肾损伤（AKI）风险增加。然而，关于老年患者AKI预测因素的研究报道较少。因此，我们旨在确定衰弱作为AKI预测因素的作用。
我们回顾性纳入了533例住院老年患者（年龄≥65岁），这些患者在2013年为期1年的住院期间测量了肌酐水平（≥1次测量），并在首次住院前1年内进行了全面老年评估（CGA）。我们从CGA中检查了五个变量（日常生活活动能力[ADL]和工具性ADL依赖、痴呆、营养和多重用药）。我们根据综合衰弱评分的三分位数将患者分为3组：第1组，评分1 - 2；第2组，评分3 - 4；第3组，评分5 - 8）。
54例患者（10.1%）发生AKI（中位持续时间，4天）。最衰弱组（第3组）与第1组相比，AKI风险增加（风险比[HR]=3.536，P = 0.002）。我们发现，将综合衰弱评分的三分位数添加到协变量中，对AKI的鉴别准确性提高（受试者操作特征曲线下面积[AUROC]分别为0.641、0.739，P = 0.004）。46例患者（8.6%）被转至护理机构，477例患者（89.5%）出院回家。老年住院患者的总体90天和1年死亡率分别为7.9%和26.3%。与第1组相比，最衰弱组转至护理机构的风险以及90天和1年死亡率也增加，且与AKI严重程度无关（护理机构：比值比=4.843，P = 0.002；90天死亡率：HR = 6.555，P = 0.002；1年死亡率：HR = 3.249，P = 0.001）。
我们发现衰弱可能独立预测老年住院患者AKI的发生和不良结局。
Zotero 插件
