美国妊娠相关急性肾损伤：临床结局与医疗保健利用情况
Pregnancy-Related Acute Kidney Injury in the United States: Clinical Outcomes and Health Care Utilization.
作者信息
Shah Silvi, Meganathan Karthikeyan, Christianson Annette L, Harrison Kathleen, Leonard Anthony C, Thakar Charuhas V
机构信息
Division of Nephrology, Kidney C.A.R.E. (Clinical Advancement, Research and Education) Program, University of Cincinnati, Cincinnati, Ohio, USA,
Department of Biomedical Informatics, University of Cincinnati, Cincinnati, Ohio, USA.
出版信息
Am J Nephrol. 2020;51(3):216-226. doi: 10.1159/000505894. Epub 2020 Feb 11.
BACKGROUND
Acute kidney injury (AKI) during pregnancy is a public health problem and is associated with maternal and fetal morbidity and mortality. Clinical outcomes and health care utilization in pregnancy-related AKI, especially in women with diabetes, are not well studied.
METHODS
Using data from the 2006 to 2015 Nationwide Inpatient Sample, we identified 42,190,790 pregnancy-related hospitalizations in women aged 15-49 years. We determined factors associated with AKI, including race/ethnicity, and associations between AKI and inpatient mortality, and between AKI and cardiovascular (CV) events, during pregnancy-related hospitalizations. We calculated health care expenditures from pregnancy-related AKI hospitalizations.
RESULTS
Overall, the rate of AKI during pregnancy-related hospitalizations was 0.08%. In the adjusted regression analysis, a higher likelihood of AKI during pregnancy-related hospitalizations was seen in 2015 (OR 2.20; 95% CI 1.89-2.55) than in 2006; in older women aged 36-40 years (OR 1.49; 95% CI 1.36-1.64) and 41-49 years (OR 2.12; 95% CI 1.84-2.45) than in women aged 20-25 years; in blacks (OR 1.52; 95% CI 1.40-1.65) and Native Americans (OR 1.45; 95% CI 1.10-1.91) than in whites, and in diabetic women (OR 4.43; 95% CI 4.04-4.86) than in those without diabetes. Pregnancy-related hospitalizations with AKI were associated with a higher likelihood of inpatient mortality (OR 13.50; 95% CI 10.47-17.42) and CV events (OR 9.74; 95% CI 9.08-10.46) than were hospitalizations with no AKI. The median cost was higher for a delivery hospitalization with AKI than without AKI (USD 18,072 vs. 4,447).
CONCLUSION
The rates of pregnancy-related AKI hospitalizations have increased during the last decade. Factors associated with a higher likelihood of AKI during pregnancy included older age, black and Native American race/ethnicity, and diabetes. Hospitalizations with pregnancy-related AKI have an increased risk of inpatient mortality and CV events, and a higher health care utilization than do those without AKI.
背景
妊娠期急性肾损伤（AKI）是一个公共卫生问题，与孕产妇和胎儿的发病率及死亡率相关。妊娠相关AKI的临床结局和医疗保健利用情况，尤其是糖尿病女性患者的情况，尚未得到充分研究。
方法
利用2006年至2015年全国住院患者样本的数据，我们确定了年龄在15 - 49岁的女性中42190790例与妊娠相关的住院病例。我们确定了与AKI相关的因素，包括种族/族裔，以及妊娠相关住院期间AKI与住院死亡率之间、AKI与心血管（CV）事件之间的关联。我们计算了妊娠相关AKI住院的医疗保健支出。
结果
总体而言，妊娠相关住院期间AKI的发生率为0.08%。在调整后的回归分析中，2015年妊娠相关住院期间发生AKI的可能性（OR 2.20；95% CI 1.89 - 2.55）高于2006年；36 - 40岁（OR 1.49；95% CI 1.36 - 1.64）和41 - 49岁（OR 2.12；95% CI 1.84 - 2.45）的老年女性发生AKI的可能性高于20 - 25岁的女性；黑人（OR 1.52；95% CI 1.40 - 1.65）和美洲原住民（OR 1.45；95% CI 1.10 - 1.91）发生AKI的可能性高于白人，糖尿病女性（OR 4.43；95% CI 4.04 - 4.86）发生AKI的可能性高于非糖尿病女性。与无AKI的住院病例相比，妊娠相关AKI的住院病例住院死亡率（OR 13.50；95% CI 10.47 - 17.42）和CV事件（OR 9.74；95% CI 9.08 - 10.46）的可能性更高。发生AKI的分娩住院的中位数费用高于未发生AKI的情况（18072美元对4447美元）。
结论
在过去十年中，妊娠相关AKI住院率有所上升。妊娠期间发生AKI可能性较高的相关因素包括年龄较大、黑人及美洲原住民种族/族裔和糖尿病。与无AKI的住院病例相比，妊娠相关AKI的住院病例住院死亡率和CV事件风险增加，医疗保健利用率更高。
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