Balogun Rasheed A, Omotoso Bolanle A, Xin Wenjun, Ma Jennie Z, Scully Kenneth W, Arogundade Fatiu A, Abdel-Rahman Emaad M
Division of Nephrology, University of Virginia, Charlottesville, Va., USA.
Nephron. 2017;135(1):23-30. doi: 10.1159/000449474. Epub 2016 Sep 22.
The prevalence of depression and its relationship to poor outcomes in chronic kidney disease are established facts. Such prognostic impact in acute kidney injury (AKI) is not known. This study determines the prognostic implication of a diagnosis of depression on renal recovery and major adverse cardiovascular events (MACE), a new diagnosis of myocardial infarction, cerebrovascular disease (CVD, stroke or transient ischemic attack) or congestive heart failure (CHF) after hospitalization with AKI.
The study population comprises adults admitted to the University of Virginia Medical Center between January 1, 2002 and December 31, 2012 who suffered AKI during admission. Long-term outcomes, MACE and all-cause mortality, were compared between 2 groups; patients with preexisting diagnosis of major depression and those without. Risk adjusted multivariable Cox proportional hazards regression examined the association between major depression and these outcomes.
Patients with AKI numbering 11,425 survived beyond 90 days and had data available. Of these patients, 2,519 (22%) were majorly affected by depression; more often, younger patients, females, African Americans, and those with more comorbid conditions, especially CHF, CVD, diabetes, peptic ulcer disease, chronic pulmonary disease and liver disease were found to be affected with depression. Crude hazard ratio for MACE was 1.245, 95% CI 1.150-1.348 and for all-cause mortality 1.186, 95% CI 1.091-1.290; p < 0.001, that is, the cohort with major depression had a long-term risk for MACE and all-cause mortality increased by 24 and 18%, respectively.
Patients who develop AKI in hospital and have preexisting major depression are at greater long-term risk of MACE and all-cause mortality.
抑郁症的患病率及其与慢性肾脏病不良预后的关系已得到证实。而其在急性肾损伤（AKI）中的预后影响尚不清楚。本研究旨在确定抑郁症诊断对肾恢复以及主要不良心血管事件（MACE）的预后影响，MACE是指急性肾损伤住院后新诊断的心肌梗死、脑血管疾病（CVD，中风或短暂性脑缺血发作）或充血性心力衰竭（CHF）。
研究人群包括2002年1月1日至2012年12月31日期间入住弗吉尼亚大学医学中心且住院期间发生急性肾损伤的成年人。比较两组的长期结局、MACE和全因死亡率；即已有重度抑郁症诊断的患者和无此诊断的患者。风险调整后的多变量Cox比例风险回归分析了重度抑郁症与这些结局之间的关联。
11425例急性肾损伤患者存活超过90天且有可用数据。在这些患者中，2519例（22%）受抑郁症严重影响；更常见的是，年轻患者、女性、非裔美国人以及合并症更多的患者，尤其是患有CHF、CVD、糖尿病、消化性溃疡病、慢性肺病和肝病的患者更容易患抑郁症。MACE 的粗风险比为1.245，95%置信区间为1.150 - 1.348，全因死亡率的粗风险比为1.186，95%置信区间为1.091 - 1.290；p < 0.001，即重度抑郁症患者发生MACE和全因死亡率的长期风险分别增加了24%和18%。
在医院发生急性肾损伤且已有重度抑郁症的患者发生MACE和全因死亡率的长期风险更高。
