Department of Acute Medicine, The University of Tokyo Hospital, Bunkyo, Tokyo, Japan.
PLoS One. 2021 Oct 14;16(10):e0258665. doi: 10.1371/journal.pone.0258665. eCollection 2021.
Acute kidney injury (AKI), chronic kidney disease (CKD), and decreased estimated glomerular filtration rate (eGFR) are all associated with poor clinical outcomes among emergency department (ED) patients. This study aimed to evaluate the effect of different types of renal dysfunction and the degree of eGFR reduction on the clinical outcomes in a real-world ED setting.
Adult patients with an eGFR lower than 60 mL/min/1.73m2 in our ED, from October 1, 2016, to December 31, 2016, were enrolled in this retrospective observational study. Besides AKI and CKD, patients with unknown baseline renal function before an ED visit were categorized in the undetermined renal dysfunction (URD) category.
Among 1495 patients who had eGFR evaluation at ED, this study finally enrolled 441 patients; 22 patients (5.0%) had AKI only, 32 (7.3%) had AKI on CKD, 196 (44.4%) had CKD only, 27 (6.1%) had subclinical kidney injury (those who met neither criteria for AKI nor CKD), and 164 (37.2%) had URD. There was a significant association between eGFR and critical illness defined as the composite outcome of death or intensive care unit (ICU) need, hospitalization, ICU need, death, and renal replacement therapy need (odds ratio [95% confidence interval]: 1.72 [1.45-2.05], 1.36 [1.16-1.59], 1.66 [1.39-2.00], 1.73 [1.32-2.28], and 2.71 [1.73-4.24] for every 10 mL/min/1.73m2 of reduction, respectively). Multivariate logistic regression analysis showed eGFR was an independent predictor of critical illness composite outcome (death or ICU need), hospitalization, and ICU need even after adjustment with AKI or URD.
Estimated GFR may be a sufficient predictor of clinical outcomes of ED patients regardless of AKI complication. Considerable ED patients were determined as URD, which might have a significant impact on the ED statistics regarding renal dysfunction.
急性肾损伤（AKI）、慢性肾脏病（CKD）和估算肾小球滤过率（eGFR）降低均与急诊科（ED）患者的不良临床结局相关。本研究旨在评估不同类型的肾功能障碍和 eGFR 降低程度对真实 ED 环境下临床结局的影响。
2016 年 10 月 1 日至 12 月 31 日，我们在 ED 中招募了 eGFR 低于 60 mL/min/1.73m2 的成年患者，进行这项回顾性观察研究。除 AKI 和 CKD 外，在 ED 就诊前基线肾功能未知的患者被归类为未确定的肾功能障碍（URD）类别。
在接受 ED eGFR 评估的 1495 名患者中，本研究最终纳入了 441 名患者；22 名患者（5.0%）仅有 AKI，32 名患者（7.3%）在 CKD 时发生 AKI，196 名患者（44.4%）仅有 CKD，27 名患者（6.1%）有亚临床肾脏损伤（既不符合 AKI 也不符合 CKD 的标准），164 名患者（37.2%）为 URD。eGFR 与危重病之间存在显著关联，危重病的定义为死亡或需要重症监护病房（ICU）、住院、需要 ICU、死亡和需要肾脏替代治疗的复合结局（优势比[95%置信区间]：每降低 10 mL/min/1.73m2，分别为 1.72[1.45-2.05]、1.36[1.16-1.59]、1.66[1.39-2.00]、1.73[1.32-2.28]和 2.71[1.73-4.24]）。多变量逻辑回归分析显示，eGFR 是危重病复合结局（死亡或 ICU 需要）、住院和 ICU 需要的独立预测因子，即使在调整 AKI 或 URD 后也是如此。
无论是否存在 AKI 并发症，eGFR 都可能是 ED 患者临床结局的充分预测指标。相当数量的 ED 患者被确定为 URD，这可能对 ED 肾功能障碍统计数据产生重大影响。
