Porter Christine J, Moppett Iain K, Juurlink Irene, Nightingale Jessica, Moran Christopher G, Devonald Mark A J
Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
Anaesthesia and Critical Care, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NG7 2RD, UK.
BMC Nephrol. 2017 Jan 14;18(1):20. doi: 10.1186/s12882-017-0437-5.
Hip fracture is a common injury in older people with a high rate of postoperative morbidity and mortality. This patient group is also at high risk of acute kidney injury (AKI) and chronic kidney disease (CKD), but little is known of the impact of kidney disease on outcome following hip fracture.
An observational cohort of consecutive patients with hip fracture in a large UK secondary care hospital. Predictive modelling of outcomes using development and validation datasets. Inclusion: all patients admitted with hip fracture with sufficient serum creatinine measurements to define acute kidney injury. Main outcome measures - development of acute kidney injury during admission; mortality (in hospital, 30-365 day and to follow-up); length of hospital stay.
Data were available for 2848 / 2959 consecutive admissions from 2007-2011; 776 (27.2%) male. Acute kidney injury occurs in 24%; development of acute kidney injury is independently associated with male sex (OR 1.48 (1.21 to 1.80), premorbid chronic kidney disease stage 3B or worse (OR 1.52 (1.19 to 1.93)), age (OR 3.4 (2.29 to 5.2) for >85 years) and greater than one major co-morbidities (OR 1.61 (1.34 to 1.93)). Acute kidney injury of any stage is associated with an increased hazard of death, and increased length of stay (Acute kidney injury: 19.1 (IQR 13 to 31) days; no acute kidney injury 15 (11 to 23) days). A simplified predictive model containing Age, CKD stage (3B-5), two or more comorbidities, and male sex had an area under the ROC curve of 0.63 (0.60 to 0.67).
Acute kidney injury following hip fracture is common and associated with worse outcome and greater hospital length of stay. With the number of people experiencing hip fracture predicted to rise, recognition of risk factors and optimal perioperative management of acute kidney injury will become even more important.
髋部骨折是老年人常见的损伤，术后发病率和死亡率较高。该患者群体急性肾损伤（AKI）和慢性肾脏病（CKD）的风险也很高，但关于肾脏疾病对髋部骨折后预后的影响知之甚少。
在英国一家大型二级医疗机构对连续的髋部骨折患者进行观察性队列研究。使用开发数据集和验证数据集对预后进行预测建模。纳入标准：所有因髋部骨折入院且有足够血清肌酐测量值以定义急性肾损伤的患者。主要结局指标：入院期间急性肾损伤的发生情况；死亡率（住院期间、30 - 365天及随访期间）；住院时间。
2007 - 2011年连续2848例（共2959例入院患者）的数据可用；男性776例（27.2%）。急性肾损伤发生率为24%；急性肾损伤的发生与男性性别独立相关（比值比1.48（1.21至1.80））、病前慢性肾脏病3B期或更严重（比值比1.52（1.19至1.93））、年龄（85岁以上者比值比3.4（2.29至5.2））以及一种以上主要合并症（比值比1.61（1.34至1.93））有关。任何阶段的急性肾损伤都与死亡风险增加和住院时间延长相关（急性肾损伤：19.1（四分位间距13至31）天；无急性肾损伤：15（11至23）天）。一个包含年龄、慢性肾脏病分期（3B - 5期）、两种或更多合并症以及男性性别的简化预测模型的ROC曲线下面积为0.63（0.60至0.67）。
髋部骨折后急性肾损伤很常见，且与更差的预后和更长的住院时间相关。随着预计髋部骨折患者数量的增加，识别危险因素以及对急性肾损伤进行最佳围手术期管理将变得更加重要。
