Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Haidian District, No 10, Tieyi Road, Beijing, People's Republic of China.
Intern Emerg Med. 2018 Jan;13(1):17-25. doi: 10.1007/s11739-017-1703-z. Epub 2017 Jun 27.
Acute kidney injury (AKI) is proven to be an independent risk factor for adverse clinical outcomes in patients with stroke, but data about the epidemiology of AKI in these patients are not well characterized. Therefore, we investigated the incidence, risk factors, and the impact of AKI on the clinical outcomes in a group of Chinese patients with stroke. We retrospectively recruited 647 stroke patients from the neurology ICU between 2012 and 2013. AKI was identified according to the 2012 KDIGO criteria. Baseline estimated glomerular filtration rate (eGFR) was calculated using modified Chronic Kidney Disease Epidemiology Collaboration equation for Chinese patients. National Institutes of Health Stroke Scale (NIHSS) score was assessed for the stroke severity. A total of 135 (20.9%) patients developed AKI. Patients with AKI stages from 1 to 3 were 84 (62.2%), 26 (19.3%), and 25 (18.5%), respectively. Logistic regression analysis showed that independent risk factors for AKI were higher NIHSS score (OR, 1.027; 95% CI 1.003-1.051), lower baseline eGFR (OR, 0.985; 95% CI 0.977-0.993), the presence of hypertension (OR, 1.592; 95% CI 1.003-2.529), and infectious complications (OR, 3.387; 95% CI 1.997-5.803) (P < 0.05 for all). AKI patients were also significantly associated with all-cause mortality in the neurology ICU [OR and 95% CI of AKI-stage 1, AKI-stage 2, and AKI-stage 3 were 4.961 (2.191-11.232), 19.722 (6.354-61.217), and 48.625 (17.616-134.222), respectively (P < 0.001 for all)]. AKI is common among patients with stroke and is associated with worse clinical outcomes after stroke. Prevention of AKI seems to be very important among these patients, because they are exposed to many risk factors for developing AKI.
急性肾损伤（AKI）已被证实是中风患者不良临床结局的独立危险因素，但这些患者中 AKI 的流行病学数据尚不清楚。因此，我们调查了一组中国中风患者的 AKI 发生率、危险因素以及对临床结局的影响。我们回顾性地招募了 2012 年至 2013 年间神经重症监护病房的 647 名中风患者。根据 2012 年 KDIGO 标准确定 AKI。使用改良的肾脏病预后质量倡议方程为中国患者计算基础估计肾小球滤过率（eGFR）。采用国立卫生研究院中风量表（NIHSS）评分评估中风严重程度。共有 135 名（20.9%）患者发生 AKI。AKI 分期 1 至 3 期的患者分别为 84 名（62.2%）、26 名（19.3%）和 25 名（18.5%）。Logistic 回归分析显示 AKI 的独立危险因素为较高的 NIHSS 评分（OR，1.027；95%CI，1.003-1.051）、较低的基础 eGFR（OR，0.985；95%CI，0.977-0.993）、高血压（OR，1.592；95%CI，1.003-2.529）和感染性并发症（OR，3.387；95%CI，1.997-5.803）（均 P<0.05）。AKI 患者在神经重症监护病房的全因死亡率也显著升高[AKI 分期 1、AKI 分期 2 和 AKI 分期 3 的 OR 和 95%CI 分别为 4.961（2.191-11.232）、19.722（6.354-61.217）和 48.625（17.616-134.222）（均 P<0.001）]。AKI 在中风患者中很常见，与中风后临床结局较差相关。在这些患者中，预防 AKI 似乎非常重要，因为他们面临许多发生 AKI 的危险因素。
