就诊前肾功能与急性肾盂肾炎住院患者急性肾损伤风险的关系：一项丹麦基于人群的队列研究。
Preadmission kidney function and risk of acute kidney injury in patients hospitalized with acute pyelonephritis: A Danish population-based cohort study.
机构信息
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
出版信息
PLoS One. 2021 Mar 3;16(3):e0247687. doi: 10.1371/journal.pone.0247687. eCollection 2021.
BACKGROUND AND OBJECTIVES
Only few smaller studies have examined if impaired kidney function increases the risk of acute kidney injury in patients with acute pyelonephritis. Therefore, we estimated 30-day risk of acute kidney injury by preadmission kidney function in patients with acute pyelonephritis. Furthermore, we examined if impaired kidney function was a risk factor for development of acute kidney injury in pyelonephritis patients.
METHODS
This cohort study included patients with a first-time hospitalization with pyelonephritis from 2000 to 2017. Preadmission kidney function (estimated glomerular filtration rate (eGFR) <30, 30-44, 45-59, 60-89, and ≥90 ml/min/1.73 m2) and acute kidney injury within 30 days after admission were assessed using laboratory data on serum creatinine. The absolute 30-days risk of acute kidney injury was assessed treating death as a competing risk. The impact of eGFR on the odds of acute kidney injury was compared by odds ratios (ORs) with 95% confidence intervals estimated using logistic regression adjusted for potential confounding factors.
RESULTS
Among 8,760 patients with available data on preadmission kidney function, 25.8% had a preadmission eGFR <60. The 30-day risk of acute kidney injury was 16% among patients with preadmission eGFR ≥90 and increased to 22%, 33%, 42%, and 47% for patients with preadmission eGFR of 60-89, 45-59, 30-44, and <30 respectively. Compared with eGFR≥90, the adjusted ORs for the subgroups with eGFR 60-89, 45-59, 30-45, and <30 were 0.95, 1.32, 1.78, and 2.19 respectively.
CONCLUSION
Acute kidney injury is a common complication in patients hospitalized with acute pyelonephritis. Preadmission impaired kidney function is a strong risk factor for development of acute kidney injury in pyelonephritis patients and more attention should be raised in prevention of pyelonephritis in patients with a low kidney function.
背景与目的
仅有少数较小的研究调查了肾功能受损是否会增加急性肾盂肾炎患者发生急性肾损伤的风险。因此，我们评估了急性肾盂肾炎患者的入院前肾功能对 30 天内急性肾损伤的风险。此外，我们还研究了肾功能受损是否是肾盂肾炎患者发生急性肾损伤的危险因素。
方法
本队列研究纳入了 2000 年至 2017 年期间首次因肾盂肾炎住院的患者。入院前肾功能（估算肾小球滤过率（eGFR）<30、30-44、45-59、60-89 和≥90ml/min/1.73m2）和入院后 30 天内急性肾损伤通过血清肌酐的实验室数据评估。使用竞争风险评估 30 天内急性肾损伤的绝对风险。通过使用逻辑回归比较 eGFR 对急性肾损伤的比值比（OR），并调整了潜在混杂因素。
结果
在 8760 名有入院前肾功能数据的患者中，25.8%的患者入院前 eGFR<60。入院前 eGFR≥90 的患者 30 天内急性肾损伤风险为 16%，而入院前 eGFR 为 60-89、45-59、30-44 和<30 的患者的风险分别增加到 22%、33%、42%和 47%。与 eGFR≥90 相比，eGFR 60-89、45-59、30-45 和<30 的亚组调整后的 OR 分别为 0.95、1.32、1.78 和 2.19。
结论
急性肾损伤是急性肾盂肾炎住院患者的常见并发症。入院前肾功能受损是肾盂肾炎患者发生急性肾损伤的强烈危险因素，在预防肾功能低下患者的肾盂肾炎时应更加重视。
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