Department of Medicine, Division of Cardiology, Medical Arts & Research Center, UT Health, San Antonio, Texas, USA.
Premier Applied Sciences, Premier Healthcare Solutions Inc., Charlotte, North Carolina, USA.
Catheter Cardiovasc Interv. 2020 Nov;96(6):1184-1197. doi: 10.1002/ccd.28824. Epub 2020 Mar 4.
To assess national trends of acute kidney injury (AKI) incidence, incremental costs, risk factors, and readmissions among patients undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) during 2012-2017.
AKI remains a serious complication for patients undergoing CAG/PCI. Evidence is lacking in contemporary AKI trends and its impact on hospital resource utilization.
Patients who underwent CAG/PCI procedures in 749 hospitals were identified from Premier Healthcare Database. AKI was defined by ICD-9/10 diagnosis codes (584.9/N17.9, 583.89/N14.1, 583.9/N05.9, E947.8/T50.8X5) during 7 days post index procedure. Multivariable regression models were used to adjust for confounders.
Among 2,763,681 patients, AKI incidence increased from 6.0 to 8.4% or 14% per year in overall patients; from 18.0 to 28.4% in those with chronic kidney disease (CKD) and from 2.4 to 4.2% in those without CKD (all p < .001). Significant risk factors for AKI included older age, being uninsured, inpatient procedures, CKD, anemia, and diabetes (all p < .001). AKI was associated with higher 30-day in-hospital mortality (OR = 2.55; 95% CI: 2.40, 2.70) and readmission risk (OR = 1.52; 95% CI: 1.50, 1.55). The AKI-related incremental cost during index visit and 30-day readmissions were estimated to be $8,416 and $580 per inpatient procedure and $927 and $6,145 per outpatient procedure. Overall excess healthcare burden associated with AKI was $1.67 billion.
AKI incidence increased significantly in this large, multifacility sample of patients undergoing CAG/PCI procedures and was associated with substantial increase in hospital costs, readmissions, and mortality. Efforts to reduce AKI risk in US healthcare system are warranted.
评估 2012-2017 年期间接受冠状动脉造影（CAG）和/或经皮冠状动脉介入治疗（PCI）的患者中急性肾损伤（AKI）的发生率、增量成本、危险因素和再入院情况。
AKI 仍然是接受 CAG/PCI 治疗的患者的严重并发症。目前缺乏关于 AKI 趋势及其对医院资源利用影响的证据。
从 Premier Healthcare Database 中确定了 749 家医院接受 CAG/PCI 手术的患者。AKI 通过 ICD-9/10 诊断代码（584.9/N17.9、583.89/N14.1、583.9/N05.9、E947.8/T50.8X5）在指数手术后 7 天内定义。多变量回归模型用于调整混杂因素。
在 2763681 名患者中，AKI 的发生率从总体患者的 6.0%增加到 8.4%或每年增加 14%；在患有慢性肾脏病（CKD）的患者中从 18.0%增加到 28.4%，在没有 CKD 的患者中从 2.4%增加到 4.2%（均 p<.001）。AKI 的显著危险因素包括年龄较大、没有保险、住院治疗、CKD、贫血和糖尿病（均 p<.001）。AKI 与 30 天内院内死亡率（OR=2.55；95%CI：2.40，2.70）和再入院风险（OR=1.52；95%CI：1.50，1.55）增加相关。指数就诊和 30 天再入院期间 AKI 相关的增量成本估计为每例住院患者 8416 美元和 580 美元，每例门诊患者 927 美元和 6145 美元。与 AKI 相关的整体医疗保健负担增加了 16.7 亿美元。
在接受 CAG/PCI 手术的大量多机构患者样本中，AKI 的发生率显著增加，与医院成本、再入院率和死亡率的大幅增加相关。美国医疗保健系统有必要努力降低 AKI 的风险。
