急性肾损伤和急性心力衰竭对住院患者死亡率的叠加有害影响。
Additive harmful effects of acute kidney injury and acute heart failure on mortality in hospitalized patients.
作者信息
Son Hyung Eun, Moon Jong Joo, Park Jeong-Min, Ryu Ji Young, Baek Eunji, Jeong Jong Cheol, Chin Ho Jun, Na Ki Young, Chae Dong-Wan, Han Seung Seok, Kim Sejoong
机构信息
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
出版信息
Kidney Res Clin Pract. 2022 Mar;41(2):188-199. doi: 10.23876/j.krcp.21.111. Epub 2021 Dec 1.
BACKGROUND
Organ crosstalk between the kidney and the heart has been suggested. Acute kidney injury (AKI) and acute heart failure (AHF) are well-known independent risk factors for mortality in hospitalized patients. This study aimed to investigate if these conditions have an additive effect on mortality in hospitalized patients, as this has not been explored in previous studies.
METHODS
We retrospectively reviewed the records of 101,804 hospitalized patients who visited two tertiary hospitals in the Republic of Korea over a period of 5 years. AKI was diagnosed using serum creatinine-based criteria, and AHF was classified using International Classification of Diseases codes within 2 weeks after admission. Patients were divided into four groups according to the two conditions. The primary outcome was all-cause mortality.
RESULTS
AKI occurred in 6.8% of all patients (n = 6,920) and AHF in 1.2% (n = 1,244). Three hundred thirty-one patients (0.3%) developed both conditions while AKI alone was present in 6,589 patients (6.5%) and AHF alone in 913 patients (0.9%). Among the 5,181 patients (5.1%) who died, 20.8% died within 1 month. The hazard ratio for 1-month mortality was 29.23 in patients with both conditions, 15.00 for AKI only, and 3.39 for AHF only. The relative excess risk of interaction was 11.85 (95% confidence interval, 2.43-21.27), and was more prominent in patients aged <75 years and those without chronic heart failure.
CONCLUSION
AKI and AHF have a detrimental additive effect on short-term mortality in hospitalized patients.
背景
已有研究表明肾脏和心脏之间存在器官相互作用。急性肾损伤（AKI）和急性心力衰竭（AHF）是住院患者死亡率的众所周知的独立危险因素。本研究旨在调查这些情况对住院患者死亡率是否具有累加效应，因为此前的研究尚未对此进行探讨。
方法
我们回顾性分析了韩国两家三级医院5年间101,804例住院患者的病历记录。采用基于血清肌酐的标准诊断AKI，并在入院后2周内使用国际疾病分类代码对AHF进行分类。根据这两种情况将患者分为四组。主要结局为全因死亡率。
结果
所有患者中，6.8%（n = 6,920）发生AKI，1.2%（n = 1,244）发生AHF。331例患者（0.3%）同时出现这两种情况，6,589例患者（6.5%）仅出现AKI，913例患者（0.9%）仅出现AHF。在5,181例死亡患者（5.1%）中，20.8%在1个月内死亡。两种情况都有的患者1个月死亡率的风险比为29.23，仅AKI患者为15.00，仅AHF患者为3.39。交互作用的相对超额风险为11.85（95%置信区间，2.43 - 21.27），在年龄<75岁且无慢性心力衰竭的患者中更为显著。
结论
AKI和AHF对住院患者的短期死亡率具有有害的累加效应。
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