在患有脓毒症急性肾损伤的患者中，长期生存情况受肾功能恢复的影响较大。
Long-term survival in patients with septic acute kidney injury is strongly influenced by renal recovery.
机构信息
The Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America.
Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy.
出版信息
PLoS One. 2018 Jun 5;13(6):e0198269. doi: 10.1371/journal.pone.0198269. eCollection 2018.
BACKGROUND
Several studies have shown that long-term survival after acute kidney injury (AKI) is reduced even if there is clinical recovery. However, we recently reported that in septic shock patients those that recover from AKI have survival similar to patients without AKI. Here, we studied a cohort with less severe sepsis to examine the effects of AKI on longer-term survival as a function of recovery by discharge.
METHODS
We analyzed patients with community-acquired pneumonia from the Genetic and Inflammatory Markers of Sepsis (GenIMS) cohort. We included patients who developed AKI (KDIGO stages 2-3) and defined renal recovery as alive at hospital discharge with return of SCr to within 150% of baseline without dialysis. Our primary outcome was survival up to 3 years analyzed using Gray's model.
RESULTS
Of the 1742 patients who survived to hospital discharge, stage 2-3 AKI occurred in 262 (15%), of which 111 (42.4%) recovered. Compared to recovered patients, patients without recovery were older (75 ±14 vs 69 ±15 years, p<0.001) and were more likely to have at least stage 1 AKI on day 1 (83% vs 52%, p<0.001). Overall, 445 patients (25.5%) died during follow-up, 23.4% (347/1480) for no AKI, 28% (31/111) for AKI with recovery and 44.3% (67/151) for AKI without recovery. Patients who did not recover had worse survival compared to no AKI (HR range 1.05-2.46, p = 0.01), while recovering patients had similar survival compared to no AKI (HR 1.01, 95%CI 0.69-1.47, p = 0.96). Absence of AKI on day 1, no in-hospital renal replacement therapy (RRT), higher Apache III score and higher baseline SCr were associated with recovery after AKI.
CONCLUSIONS
In patients with sepsis, recovery by hospital discharge is associated with long-term survival similar to patients without AKI.
背景
多项研究表明，急性肾损伤（AKI）患者即使临床康复，其长期生存率仍会降低。然而，我们最近报道称，在感染性休克患者中，那些从 AKI 中恢复的患者的生存率与没有 AKI 的患者相似。在这里，我们研究了一组病情较轻的脓毒症患者，以研究 AKI 对更长时间生存的影响，其功能是通过出院时的恢复来衡量。
方法
我们分析了来自遗传和炎症标志物脓毒症（GenIMS）队列的社区获得性肺炎患者。我们纳入了发生 AKI（KDIGO 分期 2-3 期）的患者，并将肾脏恢复定义为存活至出院且 SCr 恢复至基线的 150%以内，无需透析。我们的主要结局是使用 Gray 模型分析至 3 年的生存情况。
结果
在 1742 名存活至出院的患者中，发生 2-3 期 AKI 的有 262 例（15%），其中 111 例（42.4%）恢复。与未恢复的患者相比，恢复患者年龄较大（75±14 岁比 69±15 岁，p<0.001），且第 1 天更有可能发生至少 1 期 AKI（83%比 52%，p<0.001）。总的来说，在随访期间，445 例患者（25.5%）死亡，其中无 AKI 患者为 23.4%（347/1480），AKI 恢复患者为 28%（31/111），AKI 未恢复患者为 44.3%（67/151）。与无 AKI 患者相比，未恢复的患者生存率更差（HR 范围 1.05-2.46，p=0.01），而恢复的患者与无 AKI 患者的生存率相似（HR 1.01，95%CI 0.69-1.47，p=0.96）。第 1 天无 AKI、无院内肾脏替代治疗（RRT）、较高的 Apache III 评分和较高的基线 SCr 与 AKI 后的恢复相关。
结论
在脓毒症患者中，出院时的恢复与无 AKI 患者相似的长期生存率相关。
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