急性肾损伤的危险因素分析，包括实验室指标：一项针对住院患者的全国多中心研究。
Risk Factor Analysis for AKI Including Laboratory Indicators: a Nationwide Multicenter Study of Hospitalized Patients.
作者信息
Nie Sasa, Feng Zhe, Tang Li, Wang Xiaolong, He Yani, Fang Jingai, Li Suhua, Yang Yibin, Mao Huijuan, Jiao Jundong, Liu Wenhu, Cao Ning, Wang Wenge, Sun Jifeng, Shao Fengmin, Li Wenge, He Qiang, Jiang Hongli, Lin Hongli, Fu Ping, Zhang Xinzhou, Liu Yinghong, Wu Yonggui, Xi ChunSheng, Liang Meng, Qu Zhijie, Zhu Jun, Wu Guangli, Zheng Yali, Na Yu, Li Ying, Li Wei, Cai Guangyan, Chen Xiangmei
机构信息
Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China.
Department of Nephrology, Daping Hospital, the Third Military Medical University, Chongqing, China.
出版信息
Kidney Blood Press Res. 2017;42(5):761-773. doi: 10.1159/000484234. Epub 2017 Oct 24.
BACKGROUND/AIMS: Risk factor studies for acute kidney injury (AKI) in China are lacking, especially those regarding non-traditional risk factors, such as laboratory indicators.
METHODS
All adult patients admitted to 38 tertiary and 22 secondary hospitals in China in any one month between July and December 2014 were surveyed. AKI patients were screened according to the Kidney Disease: Improving Global Outcomes' definition of AKI. Logistic regression was used to analyze the risk factors for AKI, and Cox regression was used to analyze the risk of in-hospital mortality for AKI patients; additionally, a propensity score analysis was used to reconfirm the risk factors among laboratory indicators for mortality.
RESULTS
The morbidity of AKI was 0.97%. Independent risk factors for AKI were advancing age, male gender, hypertension, and chronic kidney disease. All-cause mortality was 16.5%. The predictors of mortality in AKI patients were advancing age, tumor, higher uric acid level and increases in Acute Physiologic Assessment and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores. The hazard ratio (HR) for mortality with uric acid levels > 9.1 mg/dl compared with ≤ 5.2 mg/dl was 1.78 (95% CI: 1.23 to 2.58) for the AKI patients as a group, and was 1.73 (95% CI: 1.24 to 2.42) for a propensity score-matched set.
CONCLUSION
In addition to traditional risk factors, uric acid level is an independent predictor of all-cause mortality after AKI.
背景/目的：中国缺乏针对急性肾损伤（AKI）的危险因素研究，尤其是关于非传统危险因素，如实验室指标的研究。
方法
对2014年7月至12月间中国38家三级医院和22家二级医院中任意一个月收治的所有成年患者进行调查。根据改善全球肾脏病预后组织（KDIGO）对AKI的定义筛选AKI患者。采用逻辑回归分析AKI的危险因素，采用Cox回归分析AKI患者的院内死亡风险；此外，采用倾向评分分析再次确认实验室指标中与死亡相关的危险因素。
结果
AKI的发病率为0.97%。AKI的独立危险因素为年龄增长、男性、高血压和慢性肾脏病。全因死亡率为16.5%。AKI患者死亡的预测因素为年龄增长、肿瘤、尿酸水平升高以及急性生理与慢性健康状况评分系统II（APACHE II）和序贯器官衰竭评估（SOFA）评分增加。与尿酸水平≤5.2 mg/dl相比，尿酸水平>9.1 mg/dl的AKI患者组的死亡风险比（HR）为1.78（95%CI：1.23至2.58），倾向评分匹配组为1.73（95%CI：1.24至2.42）。
结论
除传统危险因素外，尿酸水平是AKI后全因死亡的独立预测因素。
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