Bendall Anna C, See Emily J, Toussaint Nigel D, Fazio Timothy, Tan Sven-Jean
Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
Intern Med J. 2023 Aug;53(8):1366-1375. doi: 10.1111/imj.15787. Epub 2022 Aug 31.
There is increasing global incidence of acute kidney injury (AKI) and significant short- and long-term impacts on patients.
To determine incidence and outcomes of community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI) among inpatients in the Australian healthcare setting using modern health information systems.
A retrospective cohort study of adult patients admitted to a quaternary hospital in Melbourne, Australia, between 1 January 2018 and 31 December 2019 utilising an electronic data warehouse. Participants included adult patients admitted for >24 h who had more than one serum creatinine level recorded during admission. Kidney transplant and maintenance dialysis patients were excluded. Main outcomes measured included AKI, as classified by the Kidney Disease Improving Global Outcomes (KDIGO) criteria, hospital length of stay and 30-day mortality.
A total of 6477 AKI episodes was identified across 43 791 admissions. Of all AKI episodes, 77% (n = 5011), 15% (n = 947) and 8% (n = 519) were KDIGO stage 1, 2 and 3 respectively. HA-AKI accounted for 55.9% episodes. Patients required intensive care unit admission in 22.7% (n = 1100) of CA-AKI and 19.3% (n = 935) of HA-AKI, compared with 7.5% (n = 2815) of patients with no AKI (P = 0.001). Patients with AKI were older with more co-morbidities, particularly chronic kidney disease (CKD). Length of stay was longer in CA-AKI (8.8 days) and HA-AKI (11.8 days) compared with admissions without AKI (4.9 days; P < 0.001). Thirty-day mortality was increased with CA-AKI (10.2%) and HA-AKI (12.8%) compared with no AKI (3.7%; P < 0.001).
The incidence of AKI detected by the electronic data warehouse was higher than previously reported. Patients who experienced AKI had greater morbidity and mortality. CKD was an important risk factor for AKI in hospitalised patients.
急性肾损伤（AKI）在全球的发病率日益上升，对患者产生了重大的短期和长期影响。
利用现代健康信息系统，确定澳大利亚医疗环境中住院患者社区获得性急性肾损伤（CA-AKI）和医院获得性急性肾损伤（HA-AKI）的发病率及转归。
对2018年1月1日至2019年12月31日期间入住澳大利亚墨尔本一家四级医院的成年患者进行回顾性队列研究，使用电子数据仓库。参与者包括住院时间超过24小时且在住院期间记录了不止一次血清肌酐水平的成年患者。肾移植和维持性透析患者被排除在外。主要测量的结局包括根据改善全球肾脏病预后组织（KDIGO）标准分类的AKI、住院时间和30天死亡率。
在43791例入院患者中，共识别出6477例AKI发作。在所有AKI发作中，KDIGO 1期、2期和3期分别占77%（n = 5011）、15%（n = 947）和8%（n = 519）。HA-AKI占发作次数的55.9%。CA-AKI患者中有22.7%（n = 1100）、HA-AKI患者中有19.3%（n = 935）需要入住重症监护病房，而无AKI患者中这一比例为7.5%（n = 2815）（P = 0.001）。AKI患者年龄更大，合并症更多，尤其是慢性肾脏病（CKD）。与无AKI的入院患者相比，CA-AKI（8.8天）和HA-AKI（11.8天）的住院时间更长（4.9天；P < 0.001）。与无AKI患者（3.7%）相比，CA-AKI（10.2%）和HA-AKI（12.8%）的30天死亡率更高（P < 0.001）。
电子数据仓库检测到的AKI发病率高于先前报告。发生AKI的患者发病率和死亡率更高。CKD是住院患者发生AKI的重要危险因素。
