伴有和不伴有脓毒症的危重症患者急性肾损伤的流行病学及预后比较
Comparison of Epidemiology and Outcomes of Acute Kidney Injury in Critically Ill Patients with and without Sepsis.
作者信息
Nandagopal Nithyashree, Reddy Pavan K, Ranganathan Lakshmi, Ramakrishnan Nagarajan, Annigeri Rajiv, Venkataraman Ramesh
机构信息
Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India.
Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India.
出版信息
Indian J Crit Care Med. 2020 Apr;24(4):258-262. doi: 10.5005/jp-journals-10071-23386.
OBJECTIVES
In critically ill patients, acute kidney injury (AKI) and sepsis often coexist. This confounds the assessment of outcomes of both sepsis and AKI in these patients. Hence, in this study, we compare the outcomes of AKI with sepsis, AKI without sepsis, and sepsis without AKI against a control cohort comprising patients with neither AKI nor sepsis.
MATERIALS AND METHODS
Prospective observational study conducted in our critical care unit (CCU) between January and July 2009. Data including demographic details, acute physiology and chronic health evaluation (APACHE) III score, presence of AKI, presence of sepsis, intensive care unit (ICU) length of stay (LOS), and outcomes were collected for all patients. Acute Kidney Injury Network (AKIN) criteria were used to define the presence of AKI and American College of Critical Care Medicine 2001 definition was used to define the presence of sepsis.
RESULTS
A total of 250 patients were included in the study and 8 patients were excluded from analysis as they were discharged from hospital against medical advice. The remaining 242 patients (mean age 52.8 ± 17 years; 61.6% male; APACHE III score: 48.2 ± 24.1) were analyzed, and AKI was seen in 111 patients (45.8%). Among the patients with AKI, 55.8% (62/111) had sepsis and 44.2% (49/111) had nonseptic AKI. There was a higher need for renal replacement therapy (RRT) among patients with septic AKI in comparison to those with nonseptic AKI (19.3% vs 6.1%; = 0.04), but no mortality difference was seen between the two groups (25.8% vs 20.4%, = 0.5). Patients with sepsis and AKI had a significantly higher mortality (25.8%) compared to the patients with sepsis alone (5.6%; < 0.01).
CONCLUSION
Patients with septic AKI had a higher RRT requirement compared to patients with nonseptic AKI, but no significant differences in mortality were seen between the groups. Occurrence of AKI in septic patients substantially increases their mortality.
HOW TO CITE THIS ARTICLE
Nandagopal N, Reddy PK, Ranganathan L, Ramakrishnan N, Annigeri R, Venkataraman R. Comparison of Epidemiology and Outcomes of Acute Kidney Injury in Critically Ill Patients with and without Sepsis. Indian J Crit Care Med 2020;24(4):258-262.
目的
在危重症患者中，急性肾损伤（AKI）和脓毒症常同时存在。这使得对这些患者中脓毒症和AKI的预后评估变得复杂。因此，在本研究中，我们将伴有脓毒症的AKI、不伴有脓毒症的AKI以及不伴有AKI的脓毒症患者的预后与一个由既无AKI也无脓毒症的患者组成的对照队列进行比较。
材料与方法
2009年1月至7月在我们的重症监护病房（CCU）进行的前瞻性观察性研究。收集了所有患者的人口统计学细节、急性生理学与慢性健康状况评估（APACHE）III评分、AKI的存在情况、脓毒症的存在情况、重症监护病房（ICU）住院时间（LOS）以及预后等数据。采用急性肾损伤网络（AKIN）标准定义AKI的存在情况，采用美国危重症医学会2001年的定义定义脓毒症的存在情况。
结果
本研究共纳入250例患者，8例患者因违反医嘱出院而被排除在分析之外。对其余242例患者（平均年龄52.8±17岁；男性占61.6%；APACHE III评分：48.2±24.1）进行分析，111例患者（45.8%）出现AKI。在AKI患者中，55.8%（62/111）患有脓毒症，44.2%（49/111）患有非脓毒症性AKI。与非脓毒症性AKI患者相比，脓毒症性AKI患者对肾脏替代治疗（RRT）的需求更高（19.3%对6.1%；P = 0.04），但两组之间的死亡率无差异（25.8%对20.4%，P = 0.5）。伴有脓毒症和AKI的患者的死亡率（25.8%）明显高于单纯患有脓毒症的患者（5.6%；P < 0.01）。
结论
与非脓毒症性AKI患者相比，脓毒症性AKI患者对RRT的需求更高，但两组之间的死亡率无显著差异。脓毒症患者发生AKI会大幅增加其死亡率。
如何引用本文
Nandagopal N, Reddy PK, Ranganathan L, Ramakrishnan N, Annigeri R, Venkataraman R. 伴有和不伴有脓毒症的危重症患者急性肾损伤的流行病学及预后比较。《印度重症监护医学杂志》2020；24(4):258 - 262。
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