Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, Birmingham, UK.
Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Nephrol Dial Transplant. 2021 Dec 31;37(1):148-158. doi: 10.1093/ndt/gfaa333.
Acute kidney injury (AKI) in hospital-admitted patients is a common complication associated with increased mortality. The diagnosis of AKI relies on the ascertainment of peak increase in serum creatinine (SCr). This study evaluated the incidence of AKI using the increase from mean 7-365 days pre-admission (AKIpre) and admission (AKIadm) SCr levels, and examined the associations of AKI and changes in SCr levels with all-cause mortality.
A total of 2436 patients admitted to a tertiary hospital were recruited and followed-up for a median of 47.70 (interquartile range 18.20) months. AKI incidence and severity were defined according to the Kidney Disease: Improving Global Outcomes-AKI Guidelines. Follow-up data were collected from the Hospital Episode Statistics and Office of National Statistics. Mortality was evaluated during a short- (30 days), mid- (1 year) and long-term (4 years) period.
No difference in the AKI rates using AKIpre and AKIadm (12.5% versus 12.2%; P = 0.695) or in the AKI severity (P = 0.261) was evident. Agreement between the two definitions was modest (Kappa-statistic = 0.596, P < 0.001). Patients with AKIpre or AKIadm had increased all-cause mortality compared with those without AKI during all follow-up periods. In fully adjusted regression analysis, AKIpre [hazard ratio (HR) = 2.226, 95% confidence interval (CI) 1.140-4.347; P = 0.027] and AKIadm (HR = 2.105, 95% CI 1.090-4.064; P = 0.027) remained associated with 30-day mortality. Results for the 1- and 4-year periods were similar. Increases of >4.00 μmol/L and >6.06% from pre-admission or >6.00 μmol/L and >17.24% from admission SCr levels presented increased mortality risk during follow-up.
Use of admission or pre-admission SCr provides similar incidence rates, but they diagnose different sets of patients. Even minor increases in SCr, below those required for the classification of AKI, were associated with increased mortality. These findings can help the clinicians to identify patients at higher risk for adverse outcomes.
医院收治的患者中急性肾损伤（AKI）是一种常见的并发症，与死亡率增加有关。AKI 的诊断依赖于血清肌酐（SCr）峰值的确定。本研究使用入院前（AKIpre）和入院时（AKIadm）SCr 水平的增加来评估 AKI 的发生率，并研究 AKI 和 SCr 水平变化与全因死亡率的关系。
共纳入 2436 名入住三级医院的患者，中位随访时间为 47.70（四分位间距 18.20）个月。根据改善全球肾脏病预后组织（KDIGO）AKI 指南定义 AKI 的发生率和严重程度。随访数据来自医院住院统计和国家统计局。在短期（30 天）、中期（1 年）和长期（4 年）评估死亡率。
AKIpre 和 AKIadm 的 AKI 发生率（12.5%与 12.2%；P=0.695）或 AKI 严重程度（P=0.261）无差异。两种定义之间的一致性为中等（Kappa 统计量=0.596，P<0.001）。与无 AKI 患者相比，AKIpre 或 AKIadm 患者在所有随访期间全因死亡率均升高。在完全调整的回归分析中，AKIpre[风险比（HR）=2.226，95%置信区间（CI）1.140-4.347；P=0.027]和 AKIadm（HR=2.105，95%CI 1.090-4.064；P=0.027）与 30 天死亡率相关。1 年和 4 年期间的结果相似。入院前 SCr 水平升高>4.00 μmol/L 和>6.06%或入院 SCr 水平升高>6.00 μmol/L 和>17.24%与随访期间的死亡风险增加相关。
使用入院或入院前 SCr 提供相似的发病率，但它们诊断的是不同的患者群体。即使是 SCr 水平的轻微升高，低于 AKI 分类所需的水平，也与死亡率增加相关。这些发现可以帮助临床医生识别出发生不良结局风险较高的患者。
