创伤患者入住重症监护病房后急性肾损伤的发生率及相关因素：系统评价和荟萃分析。
The incidence and associations of acute kidney injury in trauma patients admitted to critical care: A systematic review and meta-analysis.
机构信息
From the Adult Critical Care Unit (R.Y.H., A.J.F., C.J.K., J.R.P.), The Royal London Hospital, Barts Health NHS Trust; William Harvey Research Institute (R.W.H., A.J.F., C.J.K., J.R.P.), Queen Mary University of London; and Department of Renal Medicine and Transplantation (C.J.K., J.R.P.), The Royal London Hospital, Barts Health, NHS Trust, London, United Kingdom.
出版信息
J Trauma Acute Care Surg. 2019 Jan;86(1):141-147. doi: 10.1097/TA.0000000000002085.
BACKGROUND
As more patients are surviving the initial effects of traumatic injury clinicians are faced with managing the systemic complications of severe tissue injury. Of these, acute kidney injury (AKI) may be a sentinel complication contributing to adverse outcomes.
OBJECTIVE
To establish the incidence of AKI in patients admitted to critical care after major trauma, to explore any risk factors and to evaluate the association of AKI with outcomes.
DATA SOURCES
Systematic search of MEDLINE, Excerpta Medica database and Cochrane library from January 2004 to April 2018.
STUDY SELECTION
Studies of adult major trauma patients admitted to critical care that applied consensus AKI criteria (risk injury failure loss end stage [RIFLE], AKI network, or kidney disease improving global outcomes) and reported clinical outcomes were assessed (PROSPERO Registration: CRD42017056781). Of the 35 full-text articles selected from the screening, 17 (48.6%) studies were included.
DATA EXTRACTION AND SYNTHESIS
We followed the PRISMA guidelines and study quality was assessed using the Newcastle-Ottawa score. The pooled incidence of AKI and relative risk of death were estimated using random-effects models.
MAIN OUTCOMES AND MEASURES
Incidence of AKI was the primary outcome. The secondary outcome was study-defined mortality.
RESULTS
We included 17 articles describing AKI outcomes in 24,267 trauma patients. The pooled incidence of AKI was 20.4% (95% confidence interval [CI], 16.5-24.9). Twelve studies reported the breakdown of stages of AKI with 55.7% of patients classified as RIFLE-R or stage 1, 30.3% as RIFLE-I or stage 2, and 14.0% as RIFLE-F or stage 3. The pooled relative risk of death with AKI compared was 3.6 (95% CI, 2.4-5.3). In addition, there was a concordant increase in odds of death among six studies that adjusted for multiple variables (adjusted odds ratio, 2.7; 95% CI, 1.9-3.8; p = <0.01).
CONCLUSION
Acute kidney injury is common after major trauma and associated with increased mortality. Future research is warranted to reduce the potential for harm associated with this subtype of AKI.
LEVEL OF EVIDENCE
Systematic review and meta-analysis, level III.
背景
随着越来越多的创伤患者幸存于创伤的初始效应，临床医生面临着管理严重组织损伤的全身并发症。在这些并发症中，急性肾损伤（AKI）可能是导致不良结局的标志性并发症。
目的
确定重症监护病房中因重大创伤而入院的患者 AKI 的发生率，探讨任何危险因素，并评估 AKI 与结局的相关性。
数据来源
系统检索 2004 年 1 月至 2018 年 4 月 MEDLINE、Excerpta Medica 数据库和 Cochrane 图书馆。
研究选择
纳入评估重症监护病房中因重大创伤而入院的成年患者 AKI 的应用共识 AKI 标准（风险损伤衰竭丧失终末期[RIFLE]、AKI 网络或肾脏病改善全球结局）和报告临床结局的研究（PROSPERO 注册：CRD42017056781）。在筛选出的 35 篇全文文章中，有 17 篇（48.6%）研究被纳入。
数据提取和综合
我们遵循 PRISMA 指南，并使用纽卡斯尔-渥太华量表评估研究质量。使用随机效应模型估计 AKI 的发生率和死亡的相对风险。
主要结局和测量
AKI 的发生率是主要结局。次要结局是研究定义的死亡率。
结果
我们纳入了 17 项描述 24267 例创伤患者 AKI 结局的研究。AKI 的总发生率为 20.4%（95%置信区间，16.5-24.9）。12 项研究报告了 AKI 各阶段的分类，55.7%的患者被归类为 RIFLE-R 或 1 期，30.3%为 RIFLE-I 或 2 期，14.0%为 RIFLE-F 或 3 期。与 AKI 相比，死亡的合并相对风险为 3.6（95%置信区间，2.4-5.3）。此外，在六项调整了多个变量的研究中，死亡的可能性有一致增加（调整后的优势比，2.7；95%置信区间，1.9-3.8；p<0.01）。
结论
重大创伤后 AKI 很常见，并与死亡率增加相关。需要进一步研究以降低这种 AKI 亚型相关的潜在危害。
证据水平
系统评价和荟萃分析，III 级。
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