Kolhe Nitin V, Fluck Richard J, Taal Maarten W
Department of Renal Medicine, Royal Derby Hospital, Derby, United Kingdom.
Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, United Kingdom.
PLoS One. 2017 Oct 10;12(10):e0186048. doi: 10.1371/journal.pone.0186048. eCollection 2017.
Increased in-hospital mortality associated with weekend admission has been reported for many acute conditions, but no study has investigated "weekend effect" for acute kidney injury requiring dialysis (AKI-D).
In this large, propensity score matched cohort of AKI-D, we examined the impact of weekend admission and in-centre nephrology services in 53,170 AKI-D admissions between 1st April 2003 and 31st March 2015 using a hospital episode statistic dataset. Propensity score matching (PSM) was performed to match 4284 weekend admissions with AKI-D with 14,788 admissions on weekdays.
Of the 53,170 admissions with AKI-D in the whole dataset, 12,357 (23%) were at weekends. The unadjusted mortality for weekend admissions was significantly higher compared to admissions on weekdays (40·6% versus 39·6%, p 0·046). However, in multivariable analysis of the PSM cohort, the odds of death for weekend admissions with AKI-D was 1·01 (95%CI 0·93,1·09). Mortality was higher for weekend admissions in West Midlands (odds ratio (OR) 1·32, 95% confidence interval (CI) 1·05, 1·66) and lower in East of England (OR 0·77, 95%CI 0·59, 1·00) but was not different to weekday admissions in all other regions. In 2003-04, weekend admissions had lower odds of death (OR 0·45, 95%CI 0·21, 0·96) and in 2010-11 higher odds of death (OR 1·28, 95%CI 1·00, 1·63) but in the other ten years observed, there was no significant difference in mortality between weekday and weekend admissions. Provision of in-centre nephrology services was associated with lower odds of death at 0·57 (95%CI 0·54, 0·62).
Weekend admissions in patients with AKI-D had no effect on mortality. Further research is warranted to elucidate the reasons for the lower mortality in hospitals with in-centre nephrology services.
许多急性病已报告与周末入院相关的院内死亡率增加，但尚无研究调查需要透析的急性肾损伤（AKI-D）的“周末效应”。
在这个大型的、倾向评分匹配的AKI-D队列中，我们使用医院病历统计数据集，研究了2003年4月1日至2015年3月31日期间53170例AKI-D入院病例中周末入院和中心肾病服务的影响。进行倾向评分匹配（PSM），将4284例AKI-D周末入院病例与14788例工作日入院病例进行匹配。
在整个数据集中的53170例AKI-D入院病例中，12357例（23%）在周末入院。周末入院病例的未调整死亡率显著高于工作日入院病例（40.6%对39.6%，p=0.046）。然而，在PSM队列的多变量分析中，AKI-D周末入院病例的死亡几率为1.01（95%CI 0.93，1.09）。西米德兰兹地区周末入院病例的死亡率较高（优势比（OR）1.32，95%置信区间（CI）1.05，1.66），而英格兰东部地区较低（OR 0.77，95%CI 0.59，1.00），但在所有其他地区与工作日入院病例的死亡率无差异。在2003 - 2004年，周末入院病例的死亡几率较低（OR 0.45，95%CI 0.21，0.96），而在2010 - 2011年较高（OR 1.28，95%CI 1.00，1.63），但在观察的其他十年中，工作日和周末入院病例的死亡率无显著差异。提供中心肾病服务与较低的死亡几率相关，为0.57（95%CI 0.54，0.62）。
AKI-D患者的周末入院对死亡率无影响。有必要进行进一步研究以阐明中心肾病服务医院死亡率较低的原因。
