Arnold Julia, Sims Don, Gill Paramjit, Cockwell Paul, Ferro Charles
Department of Nephrology, University Hospitals Birmingham, Birmingham, UK.
College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Clin Kidney J. 2019 May 10;13(1):46-54. doi: 10.1093/ckj/sfz049. eCollection 2020 Feb.
Acute kidney injury (AKI) diagnosis requires ascertainment of change from a known baseline. Although pre-admission serum creatinine (SCr) is recommended, to date, all studies of AKI in acute stroke have used the first SCr on admission.
All patients admitted with an acute stroke to an emergency hospital were recruited. We compared use of pre-admission SCr with admission SCr to diagnose AKI. Regression analyses were used to identify risk factors for 30-day and 1-year mortality, respectively.
A total of 1354 patients were recruited from December 2012 to September 2015. Incidence of AKI was 18.7 and 19.9% using pre-admission SCr and admission SCr, respectively. Diagnosis of AKI was associated with significantly increased 30-day and 1-year mortality. Diagnosis of AKI using pre-admission SCr had a stronger relationship with both 30-day and 1-year mortality. In 443 patients with a pre-admission SCr and at least two SCr during admission, AKI diagnosed using pre-admission SCr had a stronger relationship than AKI diagnosed using admission SCr with 30-day mortality [odds ratio (OR) = 2.64; 95% confidence interval (CI) 1.36-5.12; P = 0.004 versus OR = 2.10; 95% CI 1.09-4.03; P = 0.026] and 1-year mortality [hazard ratio (HR) = 1.90, 95% CI 1.32-2.76; P = 0.001 versus HR = 1.47; 95% CI 1.01-2.15; P = 0.046] in fully adjusted models.
AKI after stroke is common and is associated with increased 30-day and 1-year mortality. Using first SCr on admission gives a comparable AKI incidence to pre-admission SCr, but underestimates 30-day and 1-year mortality risk.
急性肾损伤（AKI）的诊断需要确定与已知基线相比的变化。尽管推荐使用入院前血清肌酐（SCr），但迄今为止，所有关于急性卒中患者AKI的研究均采用入院时首次测得的SCr。
招募所有因急性卒中入住急诊医院的患者。我们比较了使用入院前SCr和入院时SCr诊断AKI的情况。分别采用回归分析确定30天和1年死亡率的危险因素。
2012年12月至2015年9月共招募了1354例患者。使用入院前SCr和入院时SCr诊断AKI的发生率分别为18.7%和19.9%。AKI的诊断与30天和1年死亡率显著增加相关。使用入院前SCr诊断AKI与30天和1年死亡率的相关性更强。在443例有入院前SCr且入院期间至少有两次SCr检测结果的患者中，与使用入院时SCr诊断的AKI相比，使用入院前SCr诊断的AKI与30天死亡率的相关性更强[比值比（OR）=2.64；95%置信区间（CI）1.36 - 5.12；P = 0.004，而OR = 2.10；95% CI 1.09 - 4.03；P = 0.026]，在完全调整模型中与1年死亡率的相关性也更强[风险比（HR）=1.90，95% CI 1.32 - 2.76；P = 0.001，而HR = 1.47；95% CI 1.01 - 2.15；P = 0.046]。
卒中后AKI很常见，且与30天和1年死亡率增加相关。使用入院时首次测得的SCr诊断AKI的发生率与入院前SCr相当，但低估了30天和1年的死亡风险。
