急性肾损伤预测急诊普通外科患者的死亡率。

Acute kidney injury predicts mortality in emergency general surgery patients.

机构信息

Brigham and Women's Hospital, Division of Trauma, Burn, and Surgical Critical Care, Boston, Massachusetts, USA; The University of Pittsburgh Medical Center, Division of Trauma and General Surgery, Pittsburgh, PA, USA.

Brigham and Women's Hospital, Division of Trauma, Burn, and Surgical Critical Care, Boston, Massachusetts, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital Boston, Massachusetts, USA.

出版信息

Am J Surg. 2018 Sep;216(3):420-426. doi: 10.1016/j.amjsurg.2018.03.015. Epub 2018 Mar 14.

DOI:10.1016/j.amjsurg.2018.03.015

PMID:29615192

Abstract

BACKGROUND

Patients undergoing Emergency General Surgery (EGS) have increased risk of complications and death. The risk of AKI in patients undergoing EGS, along with associated outcomes, is unknown.

METHODS

This two-institution observational study included adults admitted to intensive care units between 1997 and 2012. EGS was defined by 7 procedures occurring within 48 hours of ICU admission. The main outcome studied was AKI within 5 days, along with 90-day mortality.

RESULTS

In our cohort of 59,604 patients, 1758 (2.9%) underwent EGS. Risk of AKI in EGD patients was significantly increased relative to non-EGS patients, with adjusted odds of 1.7 (95%CI 1.40-1.94; P < 0.001). Risk of renal replacement for EGS patients was also increased, with odds of 1.8 (95%CI 1.37-2.46; P < 0.001). EGS patients were at significantly higher risk of 90-day mortality, with adjusted odds of 3.1 (95%CI 2.16-4.33,p < 0.001) for AKI and 4.5 (95%CI 2.58-7.96,p < 0.001) for AKI requiring renal replacement, relative to the absence of AKI.

CONCLUSIONS

EGS is a robust risk factor for AKI in critically ill patients, the development of which is strongly predictive of increased 90-day mortality.

摘要

背景

接受急诊普通外科（EGS）治疗的患者并发症和死亡风险增加。EGS 患者发生急性肾损伤（AKI）的风险及其相关结局尚不清楚。

方法

本项两机构观察性研究纳入了 1997 年至 2012 年间入住重症监护病房的成年人。EGS 由 ICU 入院后 48 小时内发生的 7 种手术定义。主要研究结局为 5 天内 AKI，以及 90 天死亡率。

结果

在我们的 59604 名患者队列中，有 1758 名（2.9%）接受了 EGS。EGD 患者发生 AKI 的风险明显高于非 EGS 患者，调整后的优势比为 1.7（95%CI 1.40-1.94；P<0.001）。EGS 患者接受肾脏替代治疗的风险也增加，优势比为 1.8（95%CI 1.37-2.46；P<0.001）。EGS 患者 90 天死亡率显著升高，AKI 的调整优势比为 3.1（95%CI 2.16-4.33，P<0.001），需要肾脏替代治疗的 AKI 的调整优势比为 4.5（95%CI 2.58-7.96，P<0.001），均明显高于无 AKI 患者。