Cao Chang-Chun, Chen Da-Wei, Li Jing, Ma Meng-Qing, Chen Yu-Bao, Cao Yi-Zhi, Hua Xi, Shao Wei, Wan Xin
Department of Nephrology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China,
Int J Chron Obstruct Pulmon Dis. 2018 Jul 17;13:2183-2190. doi: 10.2147/COPD.S164648. eCollection 2018.
Previous studies have described the incidence, risk factors, and outcomes for patients with acute exacerbations of COPD (AECOPD) developing acute kidney injury (AKI). However, little is known about the differences between community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI) in patients with AECOPD. Thus, in this study, we compared prevalence, risk factors, and outcomes for these patients with CA-AKI and HA-AKI.
This study was conducted from January 2014 to January 2017, and data from adult inpatients with AECOPD were analyzed retrospectively. A total of 1,768 patients were included, 280 patients were identified with CA-AKI and 97 patients were with HA-AKI.
Prevalence of CA-AKI was 15.8% and that of HA-AKI was 5.5%, giving an overall AKI prevalence of 21.3%. Patients with CA-AKI had a higher prevalence of chronic kidney disease (CKD) and lower prevalence of chronic cor pulmonale than patients with HA-AKI. Risk factors for developing HA-AKI and CA-AKI were similar, such as being elderly, requirement for mechanical ventilation, and a history of coronary artery disease and CKD. Patients with HA-AKI were more likely to have stage 3 AKI and worse short-term outcomes. In comparison with patients with CA-AKI, those with HA-AKI were more likely to require non-invasive mechanical ventilation (31.3% versus 16.8%; = 0.003) and had a longer duration of mechanical ventilation (11 days versus 8 days; = 0.020), longer hospitalization (14 days versus 12 days; = 0.038), and higher inpatient mortality (32.0% versus 13.2%; < 0.001). Patients with HA-AKI had worse (multivariate-adjusted) inpatient survival than those with CA-AKI (hazard ratio, 1.7 [95% confidence interval, 1.03-2.81; = 0.038] for the HA-AKI group).
AKI was common in patients with AECOPD requiring hospitalization. CA-AKI was more common than HA-AKI but otherwise demonstrated similar demographics and risk factors. Nevertheless, patients with HA-AKI had worse short-term outcomes.
既往研究已描述慢性阻塞性肺疾病急性加重（AECOPD）患者发生急性肾损伤（AKI）的发病率、危险因素及预后。然而，对于AECOPD患者社区获得性AKI（CA-AKI）与医院获得性AKI（HA-AKI）之间的差异知之甚少。因此，在本研究中，我们比较了这些CA-AKI和HA-AKI患者的患病率、危险因素及预后。
本研究于2014年1月至2017年1月进行，对成年AECOPD住院患者的数据进行回顾性分析。共纳入1768例患者，其中280例确诊为CA-AKI，97例为HA-AKI。
CA-AKI的患病率为15.8%，HA-AKI的患病率为5.5%，总体AKI患病率为21.3%。与HA-AKI患者相比，CA-AKI患者慢性肾脏病（CKD）患病率更高，慢性肺心病患病率更低。发生HA-AKI和CA-AKI的危险因素相似，如老年、需要机械通气、有冠状动脉疾病和CKD病史。HA-AKI患者更易发生3期AKI且短期预后更差。与CA-AKI患者相比，HA-AKI患者更需要无创机械通气（31.3%对16.8%；P = 0.003），机械通气时间更长（11天对8天；P = 0.020），住院时间更长（14天对12天；P = 0.038），住院死亡率更高（32.0%对13.2%；P < 0.001）。HA-AKI患者的（多因素调整后）住院生存率低于CA-AKI患者（HA-AKI组的风险比为1.7[95%置信区间为1.03 - 2.81；P = 0.038]）。
AKI在需要住院治疗的AECOPD患者中很常见。CA-AKI比HA-AKI更常见，但在人口统计学和危险因素方面表现相似。然而，HA-AKI患者的短期预后更差。
