Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200011, P.R. China.
Division of Nephrology, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, P.R. China.
Sci Rep. 2017 Oct 24;7(1):13953. doi: 10.1038/s41598-017-13763-9.
This study aimed to describe the mortality and risk factors of in-hospital mortality from acute kidney injury (AKI) after non-cardiovascular operation in China based on a nationwide survey about AKI. The study sample was drawn from ISN AKF 0by25 China Consortiums, which is a nationwide, cross-sectional survey from 22 provinces in mainland China. AKI after non-cardiovascular operation was identified according to the 2012 KDIGO AKI creatinine criteria or expanded criteria. In total, 3468 cases were identified as hospital-acquired AKI (HA-AKI). Of these, 1059 cases were defined as AKI after major non-cardiovascular surgery. Post-operative AKI and non-operative AKI were similar in aetiology and in the need for RRT intervention. The all-cause in-hospital mortality was 17.0% (180 of 1059) among patients with AKI after a major surgery. Older age (OR = 1.14, p = 0.046), more severe comorbidities (OR = 9.29, p < 0.001), a history of CVD (OR = 1.85, p = 0.007), more severe peak AKI stage, and being located in the northwest region of China (OR = 2.47, p = 0.012) were all significantly associated with increased in-hospital mortality risk in AKI patients who underwent an operation. AKI after a non-cardiovascular operation has become a huge medical burden in China. The features of operative AKI varied substantially in different regions of China. Increased attention must be paid to the occurrence of potential intrinsic renal AKI when patients are exposed to nephrotoxic factors or comorbidities.
本研究旨在根据一项关于急性肾损伤（AKI）的全国性调查，描述中国非心血管手术后院内 AKI 死亡率和相关危险因素。研究样本来自 ISN AKF 0by25 中国联盟，这是一项来自中国大陆 22 个省份的全国性、横断面调查。根据 2012 年 KDIGO AKI 肌酐标准或扩展标准确定非心血管手术后 AKI。共确定 3468 例医院获得性 AKI（HA-AKI）。其中 1059 例被定义为重大非心血管手术后 AKI。术后 AKI 和非手术 AKI 在病因和需要肾脏替代治疗（RRT）干预方面相似。重大手术后 AKI 患者的全因院内死亡率为 17.0%（1059 例中的 180 例）。年龄较大（OR=1.14，p=0.046）、合并症更严重（OR=9.29，p<0.001）、心血管疾病（CVD）病史（OR=1.85，p=0.007）、更严重的 AKI 峰值阶段和位于中国西北地区（OR=2.47，p=0.012）与手术患者 AKI 院内死亡率风险增加显著相关。非心血管手术后 AKI 已成为中国的巨大医疗负担。中国不同地区手术相关 AKI 的特征存在显著差异。当患者暴露于肾毒性因素或合并症时，必须更加关注潜在的固有肾 AKI 的发生。
