Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China, 400038.
Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China, 400038.
J Stroke Cerebrovasc Dis. 2021 May;30(5):105688. doi: 10.1016/j.jstrokecerebrovasdis.2021.105688. Epub 2021 Mar 6.
Acute kidney injury (AKI) following intracerebral hemorrhage (ICH) is an intractable medical complication and an independent predictor of short-term mortality. However, the correlation between AKI and long-term mortality has not been fully investigated. The aim of the present study was to determine the relationship between AKI following ICH and long-term mortality in a 10-year (2010-2019) retrospective cohort.
A total of 1449 ICH patients were screened and enrolled at the Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University) from January 2010 to December 2016. The endpoint for follow-up was May 31, 2019. The estimated all-cause mortality was determined using Cox proportional hazard regression models.
Among 1449 ICH patients, 136 (9.4%) suffered from AKI, and the duration of follow-up was a median of 5.1 years (IQR 3.2-7.2). The results indicated that the risk factors for AKI without preexisting chronic kidney disease (CKD) in the multivariable analysis were age (p = 0.002), nephrotoxic antibiotics (p = 0.000), diabetes mellitus (p = 0.005), sepsis (p = 0.000), antiplatelet therapy (p = 0.002), infratentorial hemorrhage (p = 0.000) and ICH volume (p = 0.003). Age (p = 0.008), ACEIs/ARBs (p = 0.010), nephrotoxic antibiotics (p = 0.014), coronary artery disease (p = 0.009), diabetes mellitus (p = 0.014), hypertension (p = 0.000) and anticoagulant therapy (p = 0.000) were independent predictors of AKI with preexisting CKD. Meanwhile, the data demonstrated that the estimated all-cause mortality was significantly higher in ICH patients with AKI without preexisting CKD (HR 4.208, 95% CI 2.946-6.011; p = 0.000) and in ICH patients with AKI with preexisting CKD (HR 2.470, 95% CI 1.747-3.492; p = 0.000) than in those without AKI.
AKI is a long-term independent predictor of mortality in ICH patients. Thus, renal function needs to be routinely determined in ICH patients during clinical practice.
脑出血（ICH）后急性肾损伤（AKI）是一种难治性医学并发症，也是短期死亡率的独立预测因子。然而，AKI 与长期死亡率之间的相关性尚未得到充分研究。本研究旨在确定 10 年（2010-2019 年）回顾性队列中 ICH 后 AKI 与长期死亡率之间的关系。
筛选并纳入 2010 年 1 月至 2016 年 12 月第三军医大学西南医院神经外科的 1449 例 ICH 患者。随访终点为 2019 年 5 月 31 日。使用 Cox 比例风险回归模型确定全因死亡率。
在 1449 例 ICH 患者中，136 例（9.4%）发生 AKI，中位随访时间为 5.1 年（IQR 3.2-7.2）。多变量分析表明，无慢性肾脏病（CKD）的 AKI 危险因素为年龄（p=0.002）、肾毒性抗生素（p=0.000）、糖尿病（p=0.005）、脓毒症（p=0.000）、抗血小板治疗（p=0.002）、小脑幕下出血（p=0.000）和 ICH 量（p=0.003）。年龄（p=0.008）、ACEI/ARB（p=0.010）、肾毒性抗生素（p=0.014）、冠心病（p=0.009）、糖尿病（p=0.014）、高血压（p=0.000）和抗凝治疗（p=0.000）是有 CKD 的 AKI 的独立预测因素。同时，数据表明，无 CKD 的 ICH 患者 AKI（HR 4.208，95%CI 2.946-6.011；p=0.000）和有 CKD 的 ICH 患者 AKI（HR 2.470，95%CI 1.747-3.492；p=0.000）的估计全因死亡率明显高于无 AKI 的患者。
AKI 是 ICH 患者死亡的长期独立预测因子。因此，在临床实践中需要常规确定 ICH 患者的肾功能。
