Division of Nephrology, Department of Medicine, National University Hospital, Singapore, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Intensive Care Med. 2020 Jun;35(6):527-535. doi: 10.1177/0885066618764617. Epub 2018 Mar 18.
To evaluate 1-year mortality in patients with septic acute kidney injury (AKI) and to determine association between initial AKI recovery patterns ( within 5 days, beyond 5 days but , or ) and chronic kidney disease (CKD) progression.
Prospective observational study, with retrospective evaluation of initial nonconsenters, of critically ill patients with septic AKI.
We studied 207 patients (age, mean [SD]: 64 [16] years, 39% males), of which 56 (27%), 18 (9%), and 9 (4%) died in intensive care unit (ICU), post-ICU in hospital, and posthospitalization, respectively. Infections (including pneumonia) and major adverse cardiac events accounted for 64% and 12% of deaths, respectively. Factors independently associated with 1-year mortality include older age, ischemic heart disease, higher Simplified Acute Physiology Score II, central nervous system or musculoskeletal primary infections, higher daily fluid balance (FB), and frusemide administration during ICU stay (all < .05). Among 63 patients receiving renal replacement therapy (RRT), hospital mortality was higher with cumulative median FB >8 L versus ≤8 L at RRT initiation (57% vs 24%; = .009); there was trend for less ICU- and RRT-free days at day 28 in patients with higher FB pre-RRT ( = NS). Chronic kidney disease progression over 1 year developed in 21%, 30%, and 79% of 105 initial survivors with AKI reversal, recovery, and nonrecovery, respectively ( < .001). Acute kidney injury nonrecovery during hospitalization independently predicted CKD progression ( = .001).
Patients with septic AKI had 40% 1-year mortality, mainly associated with infections. High FB and frusemide administration were modifiable risk factors. Risk of CKD progression is high especially with initial AKI nonrecovery.
评估患有脓毒症急性肾损伤（AKI）患者的 1 年死亡率，并确定初始 AKI 恢复模式（5 天内、5 天后但、或）与慢性肾脏病（CKD）进展之间的关系。
这是一项前瞻性观察性研究，对脓毒症 AKI 的重症患者进行回顾性评估初始不同意者。
我们研究了 207 名患者（年龄，平均值[标准差]：64[16]岁，39%为男性），其中 56 名（27%）、18 名（9%）和 9 名（4%）分别在重症监护病房（ICU）、ICU 后住院和出院后死亡。感染（包括肺炎）和主要不良心脏事件分别占死亡的 64%和 12%。与 1 年死亡率独立相关的因素包括年龄较大、缺血性心脏病、更高的简化急性生理学评分 II、中枢神经系统或肌肉骨骼原发性感染、更高的每日液体平衡（FB）和 ICU 期间使用呋塞米（均<0.05）。在接受肾脏替代治疗（RRT）的 63 名患者中，与 RRT 开始时 FB 累积中位数≤8 L 相比，>8 L 的住院死亡率更高（57%比 24%；=0.009）；在 RRT 前 FB 较高的患者中，第 28 天 ICU 无和 RRT 天数较少的趋势（=NS）。在 105 名 AKI 逆转、恢复和未恢复的初始幸存者中，1 年后分别有 21%、30%和 79%发展为慢性肾脏病进展（<0.001）。住院期间急性肾损伤未恢复独立预测慢性肾脏病进展（=0.001）。
患有脓毒症 AKI 的患者 1 年死亡率为 40%，主要与感染有关。高 FB 和呋塞米的使用是可改变的危险因素。CKD 进展的风险很高，特别是在初始 AKI 未恢复的情况下。
