Wang Haiman, Ji Xiaojun, Wang Amanda Ying, Wu Patrick Kevin, Liu Zhuang, Dong Lei, Liu Jingfeng, Duan Meili
Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.
Division of the Renal and Metabolic, George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia.
Int J Gen Med. 2021 Sep 14;14:5631-5649. doi: 10.2147/IJGM.S320768. eCollection 2021.
Sepsis is the most common contributing factor towards development of acute kidney injury (AKI), which is strongly associated to poor prognostic outcomes. There are numerous epidemiological studies about sepsis-associated acute kidney injury (S-AKI), however current literature is limited with the majority of studies being conducted only in the intensive care unit (ICU) setting. The aim of this study was to assess the epidemiology of S-AKI in all hospitalized in-patients.
This was a retrospective population-based study using a large regional population database in Beijing city from January, 2005 to December, 2017. It included patients with S-AKI. Patients with pre-existing end-stage kidney disease (ESKD), previous history of kidney transplantation, or being pregnant were excluded. Patients' demographic characteristics, incidence, risk factors and outcomes of S-AKI were analyzed. The contrast between different time periods, different levels of hospitals, and types of the hospitals (traditional Chinese medicine hospitals (TCMHs) and western medicine hospitals (WMHs)) was also compared using Mann-Whitney -test.
A total of 19,579 patients were included. The overall incidence of S-AKI in all in-patients was 48.1%. The significant risk factors by multivariate analysis for AKI included: age, male, being treated in a level-II hospital, pre-existing hypertension, chronic kidney disease (CKD), cirrhosis, atrial fibrillation (AF), ischemic heart disease (IHD), being admitted from emergency room, ICU admission, shock, pneumonia, intra-abdominal infection, bloodstream infection, respiratory insufficiency, acute liver injury, disseminated intravascular coagulation (DIC) and metabolic encephalopathy. The overall mortality rate in this cohort was 55%. The multivariate analysis showed that the significant risk factors for mortality included: age, being treated in a level-II hospital and TCMHs, being admitted from emergency room, pre-existing comorbidities (CKD, malignancy, cirrhosis and AF), shock, pneumonia, intra-abdominal infection, bloodstream infection, central nervous system (CNS) infection and respiratory insufficiency.
AKI is a common complication in patients with sepsis, and its incidence increases over time, especially when ICU admission is required. Exploring interventional strategies to address modifiable risk factors will be important to reduce incidence and mortality of S-AKI.
脓毒症是急性肾损伤（AKI）发生发展最常见的促成因素，与不良预后密切相关。关于脓毒症相关性急性肾损伤（S-AKI）已有众多流行病学研究，然而目前的文献有限，大多数研究仅在重症监护病房（ICU）环境中进行。本研究旨在评估所有住院患者中S-AKI的流行病学情况。
这是一项基于人群的回顾性研究，使用了北京市一个大型区域人口数据库，时间跨度为2005年1月至2017年12月。研究纳入了S-AKI患者。排除已患有终末期肾病（ESKD）、有肾移植史或怀孕的患者。分析了患者的人口统计学特征、S-AKI的发病率、危险因素及预后情况。还采用Mann-Whitney检验比较了不同时间段、不同级别医院以及医院类型（中医医院（TCMHs）和西医医院（WMHs））之间的差异。
共纳入19579例患者。所有住院患者中S-AKI的总体发病率为48.1%。多因素分析显示，AKI的显著危险因素包括：年龄、男性、在二级医院接受治疗、既往有高血压、慢性肾脏病（CKD）、肝硬化、心房颤动（AF）、缺血性心脏病（IHD）、从急诊室入院、入住ICU、休克、肺炎、腹腔内感染、血流感染、呼吸功能不全、急性肝损伤、弥散性血管内凝血（DIC）和代谢性脑病。该队列的总体死亡率为55%。多因素分析表明，死亡的显著危险因素包括：年龄、在二级医院和中医医院接受治疗、从急诊室入院、既往合并症（CKD、恶性肿瘤、肝硬化和AF）、休克、肺炎、腹腔内感染、血流感染、中枢神经系统（CNS）感染和呼吸功能不全。
AKI是脓毒症患者的常见并发症，其发病率随时间增加，尤其是在需要入住ICU时。探索针对可改变危险因素的干预策略对于降低S-AKI的发病率和死亡率至关重要。
