Welsh Renal Clinical Network, Cwm Taf University Health Board, UK.
Department of Clinical Biochemistry, Cwm Taf University Health Board, Merthyr, UK.
QJM. 2017 Nov 1;110(11):741-746. doi: 10.1093/qjmed/hcx151.
The extent of patient contact with medical services prior to development of community acquired-acute kidney injury (CA-AKI)is unknown.
We examined the relationship between incident CA-AKI alerts, previous contact with hospital or primary care and clinical outcomes.
A prospective national cohort study of all electronic AKIalerts representing adult CA-AKI.
Data were collected for all cases of adult (≥18 years of age) CA-AKI in Wales between 1 November 2013 and 31 January 2017.
There were a total of 50 560 incident CA-AKI alerts. In 46.8% there was a measurement of renal function in the 30 days prior to the AKI alert. In this group, in 63.8% this was in a hospital setting, of which 37.6% were as an inpatient and 37.5% in Accident and Emergency. Progression of AKI to a higher AKI stage (13.1 vs. 9.8%, P < 0.001) (or for AKI 3 an increase of > 50% from the creatinine value generating the alert), the proportion of patients admitted to Intensive Care (5.5 vs. 4.9%, P = 0.001) and 90-day mortality (27.2 vs. 18.5%, P < 0.001) was significantly higher for patients with a recent test. 90-day mortality was highest for patients with a recent test taken in an inpatient setting prior to CA-AKI (30.9%).
Almost half of all patients presenting with CA-AKI are already known to medical services, the majority of which have had recent measurement of renal function in a hospital setting, suggesting that AKI for at least some of these may potentially be predictable and/or avoidable.
在社区获得性急性肾损伤（CA-AKI）发生之前，患者与医疗服务的接触程度尚不清楚。
我们研究了 CA-AKI 警报事件、与医院或初级保健的先前接触与临床结局之间的关系。
一项针对威尔士所有成年（≥18 岁）CA-AKI 的电子 AKI 警报的前瞻性全国队列研究。
收集了 2013 年 11 月 1 日至 2017 年 1 月 31 日期间威尔士所有成年 CA-AKI 病例的数据。
共发生 50560 例 CA-AKI 警报事件。在 46.8%的情况下，在 AKI 警报前 30 天内有肾功能测量。在这一组中，有 63.8%是在医院环境中进行的，其中 37.6%是住院患者，37.5%是在急诊室。AKI 向更高的 AKI 阶段进展（13.1%比 9.8%，P<0.001）（或对于 AKI3，从生成警报的肌酐值增加>50%），患者入住重症监护病房的比例（5.5%比 4.9%，P=0.001）和 90 天死亡率（27.2%比 18.5%，P<0.001）对于最近有检查的患者明显更高。最近一次检查是在 CA-AKI 前住院期间进行的患者 90 天死亡率最高（30.9%）。
几乎一半的 CA-AKI 患者已经为医疗服务所熟知，其中大多数在医院环境中最近进行了肾功能测量，这表明至少其中一些患者的 AKI 可能具有预测性和/或可避免性。
