Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, P.O. Box 28, FIN-20701, Turku, Finland.
Heart Center, Turku University Hospital, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland.
Injury. 2019 Dec;50(12):2268-2271. doi: 10.1016/j.injury.2019.10.008. Epub 2019 Oct 4.
Hip fracture causes disability and excess mortality in the aging population. Acute kidney injury (AKI), is known to diminish survival of critically ill and trauma patients. AKI is also a common perioperative complication among surgical patients. We examined the effect of AKI on the survival of hip fracture patients in a Finnish hip fracture population and the risk factors for AKI in a prospective study.
The study cohort constituted of 486 consecutive low-energy trauma hip fracture patients referred to Satakunta Central Hospital (Pori, Finland) and Turku University Hospital (Turku, Finland). The patients underwent standard diagnostics and treatment in the emergency department (ER) and were operated according to the local treatment protocol. Serum creatinine (sCr) was analyzed daily pre- and post-operatively during the hospital stay. Patients were divided into groups; AKI and non-AKI based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria.
The incidence of AKI in the study cohort was 8.4% (40/475). Eleven patients were excluded due to missing sCr data. The baseline characteristics of AKI and non-AKI groups differed significantly concerning baseline sCr but were otherwise similar. At 90-day follow-up, the overall mortality was 14.4%. Patients with AKI had a significantly higher mortality (35.0%) than those with no AKI (12.7%) (p < 0.001). Dementia, preoperative sCr and any stage of AKI were independent predictors for mortality. Dementia and preoperative sCr were independently associated with post-operative AKI.
In this study AKI was a significant factor associated with a 3 -fold mortality during the first three months after surgery for low-energy trauma hip fracture.
髋部骨折会导致老龄化人口残疾和死亡率增加。急性肾损伤（AKI）已知会降低危重症和创伤患者的生存率。AKI 也是手术患者围手术期的常见并发症。我们在芬兰髋部骨折人群中研究了 AKI 对髋部骨折患者生存的影响，并在一项前瞻性研究中研究了 AKI 的危险因素。
研究队列由 486 例连续低能量创伤性髋部骨折患者组成，这些患者被转诊到萨塔昆塔中央医院（芬兰波里）和图尔库大学医院（芬兰图尔库）。这些患者在急诊科（ER）接受了标准诊断和治疗，并根据当地治疗方案进行了手术。在住院期间，每天术前和术后分析血清肌酐（sCr）。根据肾脏病：改善全球预后（KDIGO）标准，患者分为 AKI 组和非 AKI 组。
研究队列中 AKI 的发生率为 8.4%（40/475）。由于 sCr 数据缺失，有 11 名患者被排除在外。AKI 组和非 AKI 组的基线特征在基线 sCr 方面差异显著，但其他方面相似。在 90 天随访时，总死亡率为 14.4%。AKI 患者的死亡率（35.0%）明显高于非 AKI 患者（12.7%）（p<0.001）。痴呆、术前 sCr 和任何阶段的 AKI 是死亡率的独立预测因素。痴呆和术前 sCr 与术后 AKI 独立相关。
在这项研究中，AKI 是与低能量创伤性髋部骨折手术后三个月内 3 倍死亡率相关的重要因素。
