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严重急性肾损伤需要肾脏替代治疗患者的死亡率预测。

Mortality Prediction in Patients with Severe Acute Kidney Injury Requiring Renal Replacement Therapy.

机构信息

Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania.

Hospital of Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania.

出版信息

Medicina (Kaunas). 2021 Oct 9;57(10):1076. doi: 10.3390/medicina57101076.

DOI:10.3390/medicina57101076
PMID:34684113
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8537734/
Abstract

: Acute kidney injury (AKI) remains a serious health condition around the world, and is related to high morbidity, mortality, longer hospitalization duration and worse long-term outcomes. The aim of our study was to estimate the significant related factors for poor outcomes of patients with severe AKI requiring renal replacement therapy (RRT). : We retrospectively analyzed data from patients ( = 573) with severe AKI requiring RRT within a 5-year period and analyzed the outcomes on discharge from the hospital. We also compared the clinical data of the surviving and non-surviving patients and examined possible related factors for poor patient outcomes. Logistic regression was used to analyze the odds ratio for patient mortality and its related factors. In 32.5% ( = 186) of the patients, the renal function improved and RRT was stopped, 51.7% ( = 296) of the patients died, and 15.9% ( = 91) of the patients remained dialysis-dependent on the day of discharge from the hospital. During the period of 5 years, the outcomes of the investigated patients did not change statistically significantly. Administration of vasopressors, aminoglycosides, sepsis, pulmonary edema, oliguria, artificial pulmonary ventilation (APV), patient age ≥ 65 y, renal cause of AKI, AKI after cardiac surgery, a combination of two or more RRT methods, dysfunction of three or more organs, systolic blood pressure (BP) ≤ 120 mmHg, diastolic BP ≤ 65 mmHg, and Sequential Organ Failure Assessment (SOFA) score on the day of the first RRT procedure ≥ 7.5 were related factors for lethal patient outcome. The mortality rate among patients with severe AKI requiring RRT is very high-52%. Patient death was significantly predicted by the causes of AKI (sepsis, cardiac surgery), clinical course (oliguria, pulmonary edema, hypotension, acidosis, lesion of other organs) and the need for a continuous renal replacement therapy.

摘要

急性肾损伤(AKI)仍然是全世界严重的健康问题,与高发病率、死亡率、住院时间延长和更差的长期预后有关。我们的研究目的是评估需要肾脏替代治疗(RRT)的严重 AKI 患者不良预后的相关因素。

我们回顾性分析了 5 年内需要 RRT 的严重 AKI 患者(n=573)的数据,并分析了出院时的结局。我们还比较了存活和非存活患者的临床数据,并检查了患者不良预后的可能相关因素。使用逻辑回归分析患者死亡率及其相关因素的比值比。在 32.5%(n=186)的患者中,肾功能改善,RRT 停止,51.7%(n=296)的患者死亡,15.9%(n=91)的患者在出院当天仍依赖透析。在 5 年期间,研究患者的结局没有统计学显著变化。血管加压素、氨基糖苷类药物、脓毒症、肺水肿、少尿、人工通气(APV)、患者年龄≥65 岁、AKI 的肾脏原因、心脏手术后 AKI、两种或更多 RRT 方法的联合使用、三个或更多器官功能障碍、收缩压(BP)≤120mmHg、舒张压≤65mmHg,以及首次 RRT 时的序贯器官衰竭评估(SOFA)评分≥7.5,是患者致命结局的相关因素。需要 RRT 的严重 AKI 患者的死亡率非常高-52%。AKI 的病因(脓毒症、心脏手术)、临床病程(少尿、肺水肿、低血压、酸中毒、其他器官损伤)和对持续肾脏替代治疗的需求,显著预测了患者的死亡。

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Clin Kidney J. 2020 Feb 10;14(2):696-703. doi: 10.1093/ckj/sfz199. eCollection 2021 Feb.
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Impact of a computerized decision support tool deployed in two intensive care units on acute kidney injury progression and guideline compliance: a prospective observational study.计算机化决策支持工具在两个重症监护病房对急性肾损伤进展和指南依从性的影响:一项前瞻性观察研究。
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Which risk predictors are more likely to indicate severe AKI in hospitalized patients?哪些风险预测因素更有可能表明住院患者的严重 AKI?
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