急性危重症患者中无预先存在的肾脏疾病的肾脏并发症和随后的死亡率。
Renal complications and subsequent mortality in acute critically ill patients without pre-existing renal disease.
机构信息
Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan (Huang, Chuang); Graduate Institute of Public Health, China Medical University, Taichung, Taiwan (Huang, Chuang); Division of Nephrology, Ministry of Health and Welfare Chiayi Hospital, Chiayi, Taiwan (Ke); Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan (Lin); College of Medicine, China Medical University, Taichung, Taiwan (Lin); Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan (Kao); Department of Nuclear Medicine and PET Center, China Medical University, Taichung, Taiwan (Kao); Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan (Kao).
Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan (Huang, Chuang); Graduate Institute of Public Health, China Medical University, Taichung, Taiwan (Huang, Chuang); Division of Nephrology, Ministry of Health and Welfare Chiayi Hospital, Chiayi, Taiwan (Ke); Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan (Lin); College of Medicine, China Medical University, Taichung, Taiwan (Lin); Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan (Kao); Department of Nuclear Medicine and PET Center, China Medical University, Taichung, Taiwan (Kao); Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan (Kao)
出版信息
CMAJ. 2018 Sep 10;190(36):E1070-E1080. doi: 10.1503/cmaj.171382.
BACKGROUND
Most studies of long-term renal outcomes after acute critical illness have enrolled patients with pre-existing renal dysfunction. We assessed renal outcomes in patients who did not have pre-existing renal disease and who were admitted to hospital for acute critical illness.
METHODS
We identified adults who did not have pre-existing renal disease and who were admitted to hospital for acute critical illness between 2000 and 2011, from the Taiwan National Health Insurance Research Database. Each patient was matched 1:2 with controls without acute critical illness, according to age, sex and index date. A subset was further matched 1:1 with controls using propensity scores. Outcomes included acute kidney injury, chronic kidney disease and end-stage renal disease.
RESULTS
We evaluated 33 613 patients with acute critical illness matched to 63 148 controls, of whom 14 218 were propensity matched to 14 218 controls. Patients with acute critical illness had incidence rates per 10 000 person-years of 9.45 for acute kidney injury, 78.3 for chronic kidney disease and 21.0 for end-stage renal disease. In the propensity-matched cohort, patients with acute critical illness had significantly higher risks of acute kidney injury (adjusted hazard ratio [aHR] 2.92, 95% confidence interval [CI] 1.78-4.77), chronic kidney disease (aHR 1.81, 95% CI 1.57-2.08), and end-stage renal disease (aHR 3.60, 95% CI 2.50-5.18). Acute critical illness conferred higher mortality risk among patients who subsequently developed end-stage renal disease (aHR 3.37, 95% CI 2.07-5.49) or chronic kidney disease (aHR 2.16, 95% CI 1.67-2.80).
INTERPRETATION
Patients with acute critical illness and without pre-existing renal disease have a higher risk of adverse renal outcomes and subsequent mortality. A resolved episode of critical illness has implications for future renal function surveillance, even in patients without pre-existing renal disease.
背景
大多数关于急性危重病后长期肾脏结局的研究都招募了存在预先存在的肾功能障碍的患者。我们评估了没有预先存在的肾脏疾病且因急性危重病住院的患者的肾脏结局。
方法
我们从台湾全民健康保险研究数据库中确定了 2000 年至 2011 年间没有预先存在的肾脏疾病且因急性危重病住院的成年人。每位患者均根据年龄、性别和索引日期与没有急性危重病的对照组进行 1:2 匹配。亚组进一步使用倾向评分与对照组 1:1 匹配。结局包括急性肾损伤、慢性肾脏病和终末期肾病。
结果
我们评估了 33613 例急性危重病患者，与 63148 例对照组相匹配，其中 14218 例采用倾向评分与 14218 例对照组相匹配。急性危重病患者每 10000 人年的急性肾损伤发生率为 9.45，慢性肾脏病发生率为 78.3，终末期肾病发生率为 21.0。在倾向评分匹配队列中，急性危重病患者的急性肾损伤风险显著升高（校正风险比[aHR] 2.92，95%置信区间[CI] 1.78-4.77）、慢性肾脏病（aHR 1.81，95% CI 1.57-2.08）和终末期肾病（aHR 3.60，95% CI 2.50-5.18）。急性危重病患者发生终末期肾病（aHR 3.37，95% CI 2.07-5.49）或慢性肾脏病（aHR 2.16，95% CI 1.67-2.80）后，死亡率风险更高。
解释
没有预先存在的肾脏疾病且因急性危重病住院的患者发生不良肾脏结局和随后死亡的风险更高。即使在没有预先存在的肾脏疾病的患者中，急性危重病的缓解也会对未来的肾功能监测产生影响。
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