Talib Sumaira, Sharif Fatima, Manzoor Sidra, Yaqub Sonia, Kashif Waqar
Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Iran J Kidney Dis. 2017 Mar;11(2):115-123.
This study aimed to determine predictors of outcomes in critically ill patients with acute kidney injury (AKI), and to study the impact of the Charlson Comorbidity Index (CCI) as a prognostic indicator.
This retrospective study included critically ill patients who were admitted with AKI or developed AKI during their hospital stay. The impact of comorbidity was evaluated by the CCI, while severity of AKI was assessed by the RIFLE criteria.
The mean age of 786 patients with AKI was 59.0 ± 17.0 years (59% men). The most common cause was sepsis in 51% of the patients. In-hospital mortality rate was 42%. The need for mechanical ventilation (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.23 to 3.04), vasoactive drugs (OR, 9.67; 95% CI, 6.35 to 14.73), dialysis (OR, 1.78; 95% CI, 1.14 to 2.78), failure class of RIFLE criteria (OR, 2.02; 95% CI, 1.00 to 4.08), and a CCI greater than 6 (OR, 2.20; 95% CI, 1.38 to 3.52) were independently associated with mortality. At 90 days of follow-up, 6% of the patients were dialysis dependent, while 32% and 62% had partial and complete recovery, respectively. In multivariable analysis, a CCI greater than 6 (OR, 0.47; 95% CI, 0.26 to 0.83), need for dialysis in hospital (OR, 0.31; 95% CI, 0.17 to 0.54), and failure class (OR, 0.19; 95% CI, 0.07 to 0.55) were independent predictors of poor renal outcomes.
The CCI independently predicts in-patient mortality and poor renal outcomes in patients with AKI.
本研究旨在确定急性肾损伤（AKI）重症患者预后的预测因素，并研究查尔森合并症指数（CCI）作为预后指标的影响。
这项回顾性研究纳入了因AKI入院或住院期间发生AKI的重症患者。通过CCI评估合并症的影响，而通过RIFLE标准评估AKI的严重程度。
786例AKI患者的平均年龄为59.0±17.0岁（59%为男性）。最常见的病因是脓毒症，占51%的患者。住院死亡率为42%。需要机械通气（比值比[OR]，1.93；95%置信区间[CI]，1.23至3.04）、血管活性药物（OR，9.67；95%CI，6.35至14.73）、透析（OR，1.78；95%CI，1.14至2.78）、RIFLE标准的衰竭分级（OR，2.02；95%CI，1.00至4.08）以及CCI大于6（OR，2.20；95%CI，1.38至3.52）与死亡率独立相关。在90天的随访中，6%的患者依赖透析，而32%和62%的患者分别有部分恢复和完全恢复。在多变量分析中，CCI大于6（OR，0.47；95%CI，0.26至0.83）、住院期间需要透析（OR，0.31；95%CI，0.17至0.54）以及衰竭分级（OR，0.19；95%CI，0.07至0.55）是肾脏预后不良的独立预测因素。
CCI可独立预测AKI患者的住院死亡率和肾脏预后不良。
