Institute of Nephrology, University Hospital of Wales, Cardiff, UK.
Medical Biochemistry Department, University Hospital of Wales, Cardiff, UK.
Nephrology (Carlton). 2020 Jun;25(6):457-466. doi: 10.1111/nep.13672. Epub 2019 Nov 27.
The epidemiology of acute kidney injury (AKI) diagnosed in the emergency department (ED) is poorly described. This study describes the incidence, demographics and outcomes of patients diagnosed with AKI in the ED (ED-AKI).
A prospective cohort study was completed in a University Teaching Hospital, (UK) between April and August 2016. In total, 20 421 adult patients attended the ED and had a serum creatinine measurement. The incident ED-AKI patient episodes were compared with a randomly selected cohort of non-AKI ED patients.
A total of 572 patients had confirmed eAlert ED-AKI (548 incident cases), incidence 2.8% (of all ED attendances). ED-AKI was associated with a 24.4% in-patient mortality (non-AKI 3.2%, P < .001) of which 22.3% of deaths occurred within 24 hours and 58% within 7 days. Progression of the admission AKI stage to a higher AKI stage was associated with a 38.8% mortality compared with a 21.4% mortality in those who did not progress (P < .001). In multivariate analysis, ED-AKI was an independent risk for mortality (hazard ratio, 6.293; 95% confidence interval, 1.887-20.790, P = .003). For those discharged from hospital, 20.4% of ED-AKI patients re-attend for acute assessment within 30-days post-discharge (non-AKI 7.6%, P < .001). At 90-days post-discharge, 10.0% of ED-AKI patients died (non-AKI 1.4%, P < .001). Twelve months post-discharge 17.8% of ED-AKI patients developed CKD progression or de-novo CKD (non-AKI 6.0%).
The ED-AKI is an independent predictor of death. Mortality is predominantly in the early stages of hospital admission, but for those who survive to discharge have significant long-term morbidity and mortality.
急诊科（ED）诊断的急性肾损伤（AKI）的流行病学情况描述甚少。本研究描述了 ED 中 AKI 患者（ED-AKI）的发病率、人口统计学特征和结局。
2016 年 4 月至 8 月，在英国一所大学教学医院进行了一项前瞻性队列研究。共有 20421 名成年患者到 ED 就诊并进行了血清肌酐测量。将确诊的 ED-AKI 患者与随机选择的非 AKI ED 患者队列进行比较。
共 572 例患者发生了确诊的 eAlert ED-AKI（548 例为新发病例），发病率为 2.8%（所有 ED 就诊患者）。ED-AKI 患者的住院病死率为 24.4%（非 AKI 患者为 3.2%，P<0.001），其中 22.3%的死亡发生在 24 小时内，58%发生在 7 天内。与未进展 AKI 阶段的患者相比，入院时 AKI 阶段进展至更高阶段与 38.8%的死亡率相关，而无进展患者的死亡率为 21.4%（P<0.001）。多变量分析显示，ED-AKI 是死亡的独立危险因素（危险比，6.293；95%置信区间，1.887-20.790，P=0.003）。对于出院的患者，20.4%的 ED-AKI 患者在出院后 30 天内再次因急性评估而就诊（非 AKI 患者为 7.6%，P<0.001）。出院后 90 天，10.0%的 ED-AKI 患者死亡（非 AKI 患者为 1.4%，P<0.001）。出院后 12 个月，17.8%的 ED-AKI 患者发生 CKD 进展或新发 CKD（非 AKI 患者为 6.0%）。
ED-AKI 是死亡的独立预测因素。死亡率主要发生在住院早期，但对于那些存活出院的患者，其具有显著的长期发病率和死亡率。
