Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China.
Trauma Intensive Care Unit, Peking University People's Hospital, Key Laboratory of Trauma and Neural Regeneration (Peking University); Ministry of Education, Beijing, China.
Ren Fail. 2021 Dec;43(1):1569-1576. doi: 10.1080/0886022X.2021.1997761.
Acute kidney injury (AKI) is widespread in the intensive care unit (ICU) and affects patient prognosis. According to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, the absolute and relative increases of serum creatinine (Scr) are classified into the same stage. Whether the prognosis of the two types of patients is similar in the ICU remains unclear.
According to the absolute and relative increase of Scr, AKI stage 1 and stage 3 patients were divided into stage 1a and 1b, stage 3a and 3b groups, respectively. Their demographics, laboratory results, clinical characteristics, and outcomes were analyzed retrospectively.
Of the 345 eligible cases, we analyzed stage 1 because stage 3a group had only one patient. Using 53 or 61.88 µmol/L as the reference Scr (Scr), no significant differences were observed in ICU mortality (=0.076, =0.070) or renal replacement therapy (RRT) ratio, (=0.356, =0.471) between stage 1a and 1b, but stage 1b had longer ICU length of stay (LOS) than stage 1a (<0.001, =0.032). In the Kaplan-Meier survival analysis, no differences were observed in ICU mortality between stage 1a and 1b (=0.378, =0.255). In a multivariate analysis, respiratory failure [HR = 4.462 (95% CI 1.144-17.401), = 0.031] and vasoactive drug therapy [HR = 4.023 (95% CI 1.584-10.216), = 0.003] were found to be independently associated with increased risk of death.
ICU LOS benefit was more prominent in KDIGO AKI stage 1a patients than in stage 1 b. Further prospective studies with a larger sample size are necessary to confirm the effectiveness of reclassification.
急性肾损伤（AKI）在重症监护病房（ICU）中广泛存在，影响患者的预后。根据肾脏病：改善全球结局（KDIGO）指南，血清肌酐（Scr）的绝对值和相对值升高均分为同一阶段。ICU 中这两种类型患者的预后是否相似尚不清楚。
根据 Scr 的绝对值和相对值升高，将 AKI 1 期和 3 期患者分别分为 1 期 a 组和 1 期 b 组、3 期 a 组和 3 期 b 组，回顾性分析其人口统计学、实验室结果、临床特征和结局。
在 345 例符合条件的病例中，我们分析了 1 期，因为 3 期 a 组只有 1 例患者。使用 53 或 61.88 μmol/L 作为参考 Scr（Scr），1 期 a 组和 1 期 b 组在 ICU 死亡率（=0.076，=0.070）或肾脏替代治疗（RRT）比例方面无显著差异，但 1 期 b 组 ICU 住院时间（LOS）长于 1 期 a 组（<0.001，=0.032）。在 Kaplan-Meier 生存分析中，1 期 a 组和 1 期 b 组 ICU 死亡率无差异（=0.378，=0.255）。多变量分析发现，呼吸衰竭[HR=4.462（95%CI 1.144-17.401），=0.031]和血管活性药物治疗[HR=4.023（95%CI 1.584-10.216），=0.003]与死亡风险增加独立相关。
KDIGO AKI 1 期 a 患者的 ICU LOS 获益较 1 期 b 患者更为显著。需要进一步进行具有更大样本量的前瞻性研究来证实重新分类的有效性。
