Li Q L, Li K, Wang X D, Zhao M
Department of Health Care, South Building, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Yi Xue Za Zhi. 2018 Jan 9;98(2):96-101. doi: 10.3760/cma.j.issn.0376-2491.2018.02.005.
To study the incidence, clinical characteristics, and prognostic impact of acute kidney injury (AKI) in very elderly patients. The very elderly patients (≥75 years) from the Geriatric Department of the Chinese PLA General Hospital between January 2007 and December 2015 were retrospectively enrolled. AKI was defined according to the 2012 Kidney Disease Improving Global Outcomes (KDIGO) criteria. AKI patients were divided into survivor group and non-survivor group by their outcomes within 90 days after AKI. Prognostic survival factors were identified using the Cox proportional hazards regression model. In total, 668 geriatric patients (39.0%) developed AKI, and 652 patients were included in the final analysis. The median age of the cohort was 87 (84-91) years, the majority (623 cases, 95.6%) of whom were male. Among these 652 patients, 308 (47.2%) had AKI stage 1, 164 (25.2%) had AKI stage 2, and 180 (27.6%) had AKI stage 3. Of the 652 AKI patients, the 90-day mortality was 33.6% (219/652). Multivariate analysis by the Cox model revealed that persistent AKI (=5.741, 95% 3.356-9.822, <0.001), more severe AKI stage (stage 2: =3.363, 95% 1.973-5.732, <0.001 and stage 3: =4.741, 95% 2.807-8.008, <0.001), high blood urea nitrogen (BUN) level (=1.025, 95% 1.014-1.037, <0.001), low body mass index (=0.939, 95% 0.897-0.984, =0.008), low mean arterial pressure (MAP) (=0.969, 95% 0.959-0.979, <0.001), low prealbumin level (=0.935, 95% 0.911-0.959, <0.001), infection (=1.410, 95% 1.055-1.884, =0.020), oliguria (=1.948, 95% 1.266-2.998, =0.002) were associated with 90-day mortality. The incidence of AKI increases significantly with advanced age. More frequent serum creatinine (SCr) measurements may be helpful for the early diagnosis of geriatric AKI. Identification of risk factors might promote more intensive monitoring and early prevention, and thus improve outcomes for very elderly patients with AKI.
研究高龄患者急性肾损伤（AKI）的发病率、临床特征及预后影响。回顾性纳入2007年1月至2015年12月期间中国人民解放军总医院老年科的高龄患者（≥75岁）。AKI根据2012年改善全球肾脏病预后组织（KDIGO）标准进行定义。AKI患者根据其AKI后90天内的结局分为存活组和非存活组。使用Cox比例风险回归模型确定预后生存因素。共有668例老年患者（39.0%）发生AKI，652例患者纳入最终分析。队列的中位年龄为87（84 - 91）岁，其中大多数（623例，95.6%）为男性。在这652例患者中，308例（47.2%）为AKI 1期，164例（25.2%）为AKI 2期，180例（27.6%）为AKI 3期。652例AKI患者中，90天死亡率为33.6%（219/652）。Cox模型多因素分析显示，持续性AKI（=5.741，95% 3.356 - 9.822，<0.001）、更严重的AKI分期（2期：=3.363，95% 1.973 - 5.732，<0.001；3期：=4.741，95% 2.807 - 8.008，<0.001）、高血尿素氮（BUN）水平（=1.025，95% 1.014 - 1.037，<0.001）、低体重指数（=0.939，95% 0.897 - 0.984，=0.008）、低平均动脉压（MAP）（=0.969，95% 0.959 - 0.979，<0.001）、低前白蛋白水平（=0.935，95% 0.911 - 0.959，<0.001）、感染（=1.410，95% 1.055 - 1.884，=0.020）、少尿（=1.948，95% 1.266 - 2.998，=0.002）与90天死亡率相关。AKI的发病率随年龄增长显著增加。更频繁地检测血清肌酐（SCr）可能有助于老年AKI的早期诊断。识别危险因素可能促进更密切的监测和早期预防，从而改善高龄AKI患者的预后。
