Thongprayoon Charat, Qureshi Fawad, Petnak Tananchai, Cheungpasitporn Wisit, Chewcharat Api, Cato Liam D, Boonpheng Boonphiphop, Bathini Tarun, Hansrivijit Panupong, Vallabhajosyula Saraschandra, Kaewput Wisit
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Division of Pulmonary and Critical Care Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Diseases. 2020 Jul 15;8(3):28. doi: 10.3390/diseases8030028.
This study aims to evaluate the risk factors and the association of acute kidney injury with treatments, complications, outcomes, and resource utilization in patients hospitalized for heat stroke in the United States. Hospitalized patients from years 2003 to 2014 with a primary diagnosis of heat stroke were identified in the National Inpatient Sample dataset. End stage kidney disease patients were excluded. The occurrence of acute kidney injury during hospitalization was identified using the hospital diagnosis code. The associations between acute kidney injury and clinical characteristics, in-hospital treatments, outcomes, and resource utilization were assessed using multivariable analyses. A total of 3346 hospital admissions were included in the analysis. Acute kidney injury occurred in 1206 (36%) admissions, of which 49 (1.5%) required dialysis. The risk factors for acute kidney injury included age 20-39 years, African American race, obesity, chronic kidney disease, congestive heart failure, and rhabdomyolysis, whereas age <20 or ≥60 years were associated with lower risk of acute kidney injury. The need for mechanical ventilation and blood transfusion was higher when acute kidney injury occurred. Acute kidney injury was associated with electrolyte and acid-base derangements, sepsis, acute myocardial infarction, ventricular arrhythmia or cardiac arrest, respiratory, circulatory, liver, neurological, hematological failure, and in-hospital mortality. Length of hospital stay and hospitalization cost were higher in acute kidney injury patients. Approximately one third of heat stroke patients developed acute kidney injury during hospitalization. Acute kidney injury was associated with several complications, and higher mortality and resource utilization.
本研究旨在评估美国因中暑住院患者的急性肾损伤的危险因素，以及急性肾损伤与治疗、并发症、预后和资源利用之间的关联。在国家住院患者样本数据集中识别出2003年至2014年期间以中暑为主要诊断的住院患者。排除终末期肾病患者。使用医院诊断代码确定住院期间急性肾损伤的发生情况。采用多变量分析评估急性肾损伤与临床特征、住院治疗、预后和资源利用之间的关联。共有3346例住院病例纳入分析。1206例（36%）住院病例发生急性肾损伤，其中49例（1.5%）需要透析。急性肾损伤的危险因素包括20 - 39岁、非裔美国人种族、肥胖、慢性肾病、充血性心力衰竭和横纹肌溶解，而年龄<20岁或≥60岁与急性肾损伤风险较低相关。发生急性肾损伤时，机械通气和输血的需求更高。急性肾损伤与电解质和酸碱紊乱、脓毒症、急性心肌梗死、室性心律失常或心脏骤停、呼吸、循环、肝脏、神经、血液系统功能衰竭以及住院死亡率相关。急性肾损伤患者的住院时间和住院费用更高。约三分之一的中暑患者在住院期间发生急性肾损伤。急性肾损伤与多种并发症相关，且死亡率和资源利用率更高。
