Tang Xiaojing, Chen Dongping, Yu Shengqiang, Yang Li, Mei Changlin
Division of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
Renal Division, Peking University First Hospital, Beijing, China.
PLoS One. 2017 Feb 2;12(2):e0171202. doi: 10.1371/journal.pone.0171202. eCollection 2017.
The inpatient morbidity and mortality of acute kidney injury (AKI) vary considerably in different clinical units, yet studies to compare the difference remain limited.
We compared the clinical characteristics of AKI in Intensive Care Unit (ICU), medical and surgical departments by using the data derived from the 2013 nationwide cross-sectional survey of AKI in China to capture variations among different clinical departments in recognition, management, and outcomes of AKI. Suspected AKI patients were identified based on changes in serum creatinine during hospitalization, and confirmed by reviewing medical records.
The detection rate of AKI was the highest in ICU (22.46%), followed by the rates in medical (1.96%) and surgical departments (0.96%). However, the absolute number of cases was the largest in medical departments, which contributed to 50% of the cases. In medical departments, 78% of AKI cases were extensively distributed in cardiac, nephrology, oncology, gastroenterology, pneumology and neurology departments. In contrast, 87% of AKI cases in surgical departments were mainly from urology, general surgery and cardiothoracic departments. The in-time recognition rates were extremely low in all departments except nephrology. Only 10.5~15.0% AKI patients from non-nephrology departments received renal referral. Among all the death cases, 50% and 39% came from ICU and medical departments while only 11% from surgical departments. Older age, higher AKI stage and renal replacement therapy indication were identified as risk factors for high mortality in all departments. Delayed recognition and no renal referral were significantly associated with increased mortality in medical and ICU patients.
These findings suggest that ICU and medical departments are major affected departments in China with a large number of AKI cases and subsequent high mortality. The reality is more alarming considering the low awareness of AKI and the paucity of effective interventions in the high-risk patients in these departments.
急性肾损伤（AKI）患者的住院发病率和死亡率在不同临床科室差异很大，但比较这些差异的研究仍然有限。
我们利用2013年中国全国性AKI横断面调查的数据，比较了重症监护病房（ICU）、内科和外科中AKI的临床特征，以了解不同临床科室在AKI的识别、管理和结局方面的差异。根据住院期间血清肌酐的变化确定疑似AKI患者，并通过查阅病历进行确诊。
AKI的检出率在ICU中最高（22.46%），其次是内科（1.96%）和外科（0.96%）。然而，病例绝对数在内科最多，占病例总数的50%。在内科，78%的AKI病例广泛分布于心内科、肾内科、肿瘤科、消化内科、呼吸科和神经内科。相比之下，外科87%的AKI病例主要来自泌尿外科、普通外科和心胸外科。除肾内科外，所有科室的及时识别率都极低。非肾内科只有10.5%~15.0%的AKI患者接受了肾脏专科转诊。在所有死亡病例中，50%和39%分别来自ICU和内科，而只有11%来自外科。高龄、更高的AKI分期和肾脏替代治疗指征被确定为所有科室高死亡率的危险因素。识别延迟和未进行肾脏专科转诊与内科和ICU患者死亡率增加显著相关。
这些发现表明，ICU和内科是中国受影响的主要科室，AKI病例数量众多，随后死亡率很高。考虑到这些科室对AKI的认识不足以及对高危患者缺乏有效的干预措施，实际情况更令人担忧。
