Section of Internal Medicine, Department of Hospital Medicine, 12280Wake Forest University School of Medicine, Winston Salem, NC, USA.
Division of Nephrology, Department of Internal Medicine, 164186University of Massachusetts School of Medicine, Worcester, MA, USA.
J Intensive Care Med. 2021 May;36(5):550-556. doi: 10.1177/0885066620911353. Epub 2020 Apr 3.
Acute kidney injury (AKI) is common among cardiac arrest survivors. However, the outcomes and predictors are not well studied.
This is a cohort study of cardiac arrest patients enrolled from January 2012 to December 2016 who were able to survive for 24 hours post-cardiopulmonary resuscitation. Patients with anuria, chronic kidney disease (stage 5), and end-stage renal disease were excluded. Acute kidney injury (stage 1) or higher was defined using Kidney Disease: Improving Global Outcomes classification. Multivariable adjusted regression models were used to compute hazard ratio (HR) for association of AKI with risk of mortality and odds ratio (OR) with risk of poor neurological outcomes after adjusting for demographics, comorbidities, and medical therapy. Multivariable logistic regression model was used to compute OR for association of various predictors with AKI.
Of 842 cardiac arrest survivors, 588 (69.8%) developed AKI. Among AKI patients, 69.4% died compared with 52.0% among non-AKI patients. In multivariable adjusted Cox proportional hazard model, development of AKI post-cardiac arrest was significantly associated with mortality (HR: 1.35; 95% confidence interval [CI]: 1.07-1.71, = .01) and poor neurological outcomes defined as cerebral performance category >2 (OR: 2.27; 95% CI: 1.45-3.57, < .001) and modified Rankin scale >3 (OR: 2.22; 95% CI: 1.43-3.45, < .001). Postdischarge dialysis was also associated with increased risk of mortality (HR: 2.57; 95% CI: 1.57-4.23, < .001). Use of vasopressors was strongly associated with development of AKI and continued need for postdischarge dialysis.
Acute kidney injury was associated with increased risk of mortality and poor neurological outcomes. There is need for further studies to prevent AKI in cardiac arrest survivors.
心脏骤停幸存者中常发生急性肾损伤（AKI）。然而，其预后和预测因素尚未得到充分研究。
这是一项队列研究，纳入了 2012 年 1 月至 2016 年 12 月期间能够在心肺复苏后存活 24 小时的心脏骤停患者。排除无尿、慢性肾脏病（5 期）和终末期肾病患者。使用肾脏病：改善全球结局（KDIGO）分类定义 AKI（1 期或更高）。多变量调整回归模型用于计算 AKI 与死亡率风险的风险比（HR），并在调整人口统计学、合并症和药物治疗后计算 AKI 与不良神经结局风险的比值比（OR）。多变量逻辑回归模型用于计算各种预测因素与 AKI 的 OR。
在 842 名心脏骤停幸存者中，588 名（69.8%）发生 AKI。在 AKI 患者中，69.4%死亡，而非 AKI 患者中为 52.0%。在多变量调整 Cox 比例风险模型中，心脏骤停后 AKI 的发生与死亡率显著相关（HR：1.35；95%置信区间[CI]：1.07-1.71， =.01）和定义为脑功能状态分类（CPC）>2 的不良神经结局（OR：2.27；95% CI：1.45-3.57， <.001）和改良 Rankin 量表（mRS）>3（OR：2.22；95% CI：1.43-3.45， <.001）。出院后透析也与死亡率增加相关（HR：2.57；95% CI：1.57-4.23， <.001）。血管加压药的使用与 AKI 的发生和持续需要出院后透析密切相关。
AKI 与死亡率和不良神经结局风险增加相关。需要进一步研究以预防心脏骤停幸存者的 AKI。
