Trongtrakul Konlawij, Sawawiboon Chaiwut, Wang Amanda Y, Chitsomkasem Anusang, Limphunudom Ploynapas, Kurathong Sathit, Prommool Surazee, Trakarnvanich Thananda, Srisawat Nattachai
Critical Care Division, Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Renal and Metabolic Division, The George Institute for Global Health, Camperdown, New South Wales, Australia.
Nephrology (Carlton). 2019 Jan;24(1):39-46. doi: 10.1111/nep.13192.
Acute kidney injury (AKI) is one of the most serious complications seen in intensive care units (ICUs). However, its epidemiology, risk factors and clinical outcomes in surgical critically ill patients remains unclear.
A prospective cohort study was conducted in surgical intensive care unit (ICU) of the university hospital in Bangkok, Thailand. AKI was diagnosed according to the KDIGO 2012 criteria.
A total of 189 of the 400 patients enrolled in our study developed AKI (47.3%). The severity was: stage 1 = 29.6% of all AKI (56 cases), stage 2 = 30.7% (58 cases), and stage 3 = 39.7% (75 cases). Risk factors of AKI development included a higher BMI, a greater APACHE-II score, septic shock, use of mechanical ventilation, acute medical complications during surgical admission, and pre-existing chronic kidney disease. After adjustment for covariates, only the most severe stage of AKI (stage 3) was associated with increasing 28-day ICU mortality compared with no AKI stage, HR = 7.75 (95% CI, 1.46-41.20, P = 0.02).
Acute kidney injury is common and is associated with an increase in mortality in surgical ICU patients. There should be more focus on patients with AKI risk factors to prevent this deleterious event.
急性肾损伤（AKI）是重症监护病房（ICU）中最严重的并发症之一。然而，其在外科重症患者中的流行病学、危险因素及临床结局仍不明确。
在泰国曼谷大学医院的外科重症监护病房（ICU）进行了一项前瞻性队列研究。根据KDIGO 2012标准诊断AKI。
本研究纳入的400例患者中，共有189例发生AKI（47.3%）。严重程度为：1期占所有AKI的29.6%（56例），2期占30.7%（58例），3期占39.7%（75例）。AKI发生的危险因素包括较高的体重指数、较高的急性生理与慢性健康状况评分系统II（APACHE-II）评分、感染性休克、机械通气的使用、手术入院期间的急性内科并发症以及既往存在的慢性肾脏病。在对协变量进行校正后，与无AKI期相比，仅最严重的AKI期（3期）与28天ICU死亡率增加相关，风险比（HR）=7.75（95%置信区间，1.46 - 41.20，P = 0.02）。
急性肾损伤在外科ICU患者中很常见，且与死亡率增加相关。应更加关注具有AKI危险因素的患者，以预防这一有害事件。
