外科重症监护病房急性肾损伤的患病率、结局及危险因素：一项基于泰国多所大学外科重症监护病房的多中心研究（泰国外科重症监护病房研究）

Prevalence, Outcomes and Risk factors of Acute Kidney Injury in Surgical Intensive Care Unit: A Multi-Center Thai University-Based Surgical Intensive Care Units Study (THAI-SICU Study).

作者信息

Pisitsak Chawika, Chittawatanarat Kaweesak, Wacharasint Petch, Chaiwat Onuma, Komonhirun Rojnarin, Morakul Sunthiti

出版信息

J Med Assoc Thai. 2016 Sep;99 Suppl 6:S193-S200.

Abstract

OBJECTIVE

Acute kidney injury (AKI) is one of the most common problems in critically ill patients. AKI associates with poor outcome in ICU. The recognition of the prevalence and risk factors of AKI is important. This could lead to the prevention of AKI and improve patient’s outcome. This study aims to identify the prevalence, outcomes and independent risk factors of AKI in Thai surgical intensive care units.

MATERIAL AND METHOD

We conducted the prospective cohort study from nine university-based SICUs. The patients were diagnosed AKI by Acute Kidney Injury Network (AKIN) classification. The types of RRT and outcomes including mortality were collected. The risk factors of AKI were identified.

RESULTS

A total cohort of 4,652 patients was included for the present study. AKI was diagnosed in 786 (16.89%) patients. The ICU mortality was higher in patients with AKI (29.90% vs. 5.48%, p-value <0.001). Among patients with AKI staging, we found that those with AKIN III had higher ICU mortality compared to patients with AKIN II and AKIN I respectively (47.66% vs. 26.67% vs. 14.69%, p-value <0.001). Patients with AKI had higher 28 day-mortality compared with those without AKI (37.53% vs. 8.98%, p-value <0.001). The independent risk factors of AKI were higher APACHE II scores (OR 1.04, 95% CI 1.01-1.06, p-value = 0.001), lower serum albumin (OR 0.82, 95% CI 0.70-0.97, p-value = 0.020), organ failures which were in the gastrointestinal system (OR 1.53, 95% CI 1.13-2.08, p-value = 0.007), cardiovascular system (OR 1.95, 95% CI 1.34-2.83, p-value <0.001), neurological system (OR 1.37, 95% CI 1.02-1.85, p-value = 0.038) and urinary system (OR 7.00, 95% CI 5.21-9.40, p-value <0.001).

CONCLUSION

Acute kidney injury associates with poor outcomes including increased ICU and 28-day mortality. Independent risk factors of AKI in the present study were higher APACHE II scores, lower serum albumin and organ failures on admission.

摘要

目的

急性肾损伤（AKI）是重症患者最常见的问题之一。AKI与重症监护病房（ICU）患者的不良预后相关。认识AKI的患病率和危险因素很重要。这有助于预防AKI并改善患者预后。本研究旨在确定泰国外科重症监护病房中AKI的患病率、预后及独立危险因素。

材料与方法

我们在9家大学附属医院的外科重症监护病房进行了前瞻性队列研究。采用急性肾损伤网络（AKIN）分类法诊断患者是否患有AKI。收集肾脏替代治疗（RRT）的类型及包括死亡率在内的预后情况。确定AKI的危险因素。

结果

本研究共纳入4652例患者。其中786例（16.89%）被诊断为AKI。AKI患者的ICU死亡率更高（29.90%对5.48%，p值<0.001）。在AKI分期患者中，我们发现AKIN III期患者的ICU死亡率分别高于AKIN II期和AKIN I期患者（47.66%对26.67%对14.69%，p值<0.001）。AKI患者的28天死亡率高于非AKI患者（37.53%对8.98%，p值<0.001）。AKI的独立危险因素包括较高的急性生理与慢性健康状况评分系统（APACHE）II评分（比值比[OR]1.04，95%置信区间[CI]1.01 - 1.06，p值 = 0.001）、较低的血清白蛋白水平（OR 0.82，95% CI 0.70 - 0.97，p值 = 0.020）、入院时出现的器官功能衰竭，包括消化系统（OR 1.53，95% CI 1.13 - 2.08，p值 = 0.007）、心血管系统（OR 1.95，95% CI 1.34 - 2.83，p值<0.001）、神经系统（OR 1.37，95% CI 1.02 - 1.85，p值 = 0.038）和泌尿系统（OR 7.00，95% CI 5.21 - 9.40，p值<0.001）。