Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida.
Precision and intelligent Systems in Medicine (Prisma ), University of Florida, Gainesville, Florida.
Ann Surg. 2022 Jun 1;275(6):1184-1193. doi: 10.1097/SLA.0000000000004360. Epub 2020 Nov 13.
To characterize endothelial function, inflammation, and immunosuppression in surgical patients with distinct clinical trajectories of AKI and to determine the impact of persistent kidney injury and renal non-recovery on clinical outcomes, resource utilization, and long-term disability and survival.
AKI is associated with increased healthcare costs and mortality. Trajectories that account for duration and recovery of AKI have not been described for sepsis patients, who are uniquely vulnerable to renal dysfunction.
This prospective observational study included 239 sepsis patients admitted and enrolled between January 2015 and July 2017. Kidney Disease: Improving Global Outcomes (KDIGO) and Acute Disease Quality Initiative (ADQI) criteria were used to classify subjects as having no AKI, rapidly reversed AKI, persistent AKI with renal recovery, or persistent AKI without renal recovery. Serial biomarker profiles, clinical outcomes, resource utilization, and long-term physical performance status and survival were compared among AKI trajectories.
Sixty-two percent of the study population developed AKI. Only one-third of AKI episodes rapidly reversed within 48 hours; the remaining had persistent AKI, among which 57% did not have renal recovery by discharge. One-year survival and proportion of subjects fully active 1 year after sepsis was lowest among patients with persistent AKI compared with other groups. Long-term mortality hazard rates were 5-fold higher for persistent AKI without renal recovery compared with no AKI.
Among critically ill surgical sepsis patients, persistent AKI and the absence of renal recovery are associated with distinct early and sustained immunologic and endothelial biomarker signatures and decreased long-term physical function and survival.
描述具有不同急性肾损伤（AKI）临床轨迹的手术患者的内皮功能、炎症和免疫抑制情况，并确定持续的肾脏损伤和肾脏无恢复对临床结局、资源利用以及长期残疾和生存的影响。
AKI 与医疗保健费用增加和死亡率升高有关。尚未对脓毒症患者进行描述 AKI 持续时间和恢复情况的轨迹，而脓毒症患者肾脏功能障碍的风险独特。
这项前瞻性观察性研究纳入了 2015 年 1 月至 2017 年 7 月期间收治和入组的 239 例脓毒症患者。采用肾脏疾病：改善全球结局（KDIGO）和急性疾病质量倡议（ADQI）标准将患者分类为无 AKI、AKI 快速逆转、持续性 AKI 伴肾脏恢复和持续性 AKI 无肾脏恢复。比较 AKI 轨迹之间的连续生物标志物谱、临床结局、资源利用以及长期身体表现状态和生存情况。
研究人群中有 62%发生了 AKI。只有三分之一的 AKI 发作在 48 小时内迅速逆转；其余的 AKI 持续存在，其中 57%在出院时没有肾脏恢复。与其他组相比，持续性 AKI 患者的 1 年生存率和 1 年后完全活跃的患者比例最低。与无 AKI 相比，持续性 AKI 无肾脏恢复的长期死亡率风险高 5 倍。
在重症外科脓毒症患者中，持续性 AKI 和肾脏无恢复与独特的早期和持续的免疫和内皮生物标志物特征以及长期身体功能和生存下降相关。
