Department of Health Care, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China.
Department of Clinical Data Repository, Chinese PLA General Hospital, Beijing, China.
Clin Interv Aging. 2018 Jun 20;13:1151-1160. doi: 10.2147/CIA.S162899. eCollection 2018.
To compare the differences between the Kidney Disease Improving Global Outcomes (KDIGO) criteria of the 48-hour window and the 7-day window in the diagnosis of acute kidney injury (AKI) in very elderly patients, as well as the relationship between the 48-hour and 7-day windows for diagnosis and 90-day mortality.
We retrospectively enrolled very elderly patients (≥75 years old) from the geriatrics department of the Chinese PLA General Hospital between January 2007 and December 2015. AKI patients were divided into 48-hour and 7-day groups by their diagnosis criteria. AKI patients were divided into survivor and nonsurvivor groups by their outcomes within 90 days after diagnosis of AKI.
In total, 652 patients were included in the final analysis. The median age of the cohort was 87 (84-91) years, the majority (623, 95.6%) of whom were male. Of the 652 AKI patients, 334 cases (51.2%) were diagnosed with AKI by the 48-hour window for diagnosis, while 318 cases (48.8%) were by the 7-day window for diagnosis. The 90-day mortality was 42.5% in patients with 48-hour window AKI and 24.2% in patients with 7-day window AKI. Kaplan-Meier curves showed that 90-day mortality was lower in the 7-day window AKI group than in the 48-hour window AKI group (log rank: <0.001). Multivariate analysis by the Cox model revealed that 48-hour window for diagnosis hazard ratio (HR=1.818; 95% CI: 1.256-2.631; =0.002) was associated with higher 90-day mortality.
The 90-day mortality was higher in 48-hour window AKI than in 7-day window AKI in very elderly patients. The 48-hour KDIGO window definition may be less sensitive. The 48-hour KDIGO window definition is significantly better correlated with subsequent mortality and is, therefore, still appropriate for clinical use. Finding early, sensitive biomarkers of kidney damage is a future direction of research.
比较急性肾损伤（AKI）非常老年患者中 48 小时窗和 7 天窗的肾脏疾病改善全球结局（KDIGO）标准之间的差异，以及诊断的 48 小时窗和 7 天窗与 90 天死亡率之间的关系。
我们回顾性地纳入了 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非常老年患者（≥75 岁）。根据诊断标准，将 AKI 患者分为 48 小时窗组和 7 天窗组。根据 AKI 诊断后 90 天内的结局，将 AKI 患者分为存活组和非存活组。
共纳入 652 例患者进行最终分析。队列的中位年龄为 87（84-91）岁，其中 623 例（95.6%）为男性。652 例 AKI 患者中，334 例（51.2%）通过 48 小时窗诊断 AKI，318 例（48.8%）通过 7 天窗诊断 AKI。48 小时窗 AKI 患者的 90 天死亡率为 42.5%，7 天窗 AKI 患者的 90 天死亡率为 24.2%。Kaplan-Meier 曲线显示，7 天窗 AKI 组 90 天死亡率低于 48 小时窗 AKI 组（对数秩检验：<0.001）。Cox 模型的多变量分析显示，48 小时窗诊断的危险比（HR=1.818；95%CI：1.256-2.631；=0.002）与较高的 90 天死亡率相关。
非常老年患者中，48 小时窗 AKI 的 90 天死亡率高于 7 天窗 AKI。48 小时 KDIGO 窗定义的敏感性可能较低。48 小时 KDIGO 窗定义与随后的死亡率显著相关，因此仍适用于临床应用。寻找早期、敏感的肾脏损伤生物标志物是未来的研究方向。
