Li Qinglin, Cai Xiaoyan, Li Guanggang, Ju Hongyan, Li Dawei, Zhou Feihu
Department of Critical Care Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China.
Department of Nephrology, the Second Medical Center, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China.
Risk Manag Healthc Policy. 2022 Apr 26;15:793-804. doi: 10.2147/RMHP.S361598. eCollection 2022.
Acute kidney injury (AKI) in elderly patients is associated with higher hospital mortality. However, the relationship between AKI and peri-intubation complications is unclear.
This retrospective, observational, multicenter cohort study enrolled 3271 consecutive elderly patients (≥75 years) who received invasive mechanical ventilation (MV) in four medical centers of Chinese PLA General Hospital from 2008 to 2020. AKI was diagnosed according to the 2012 KDIGO criteria by an absolute increase in serum creatinine of ≥26.5 µmol/L within the first 48 hours of MV. We recorded subsequent in-hospital complications, including incident gastrointestinal bleeding, new-onset electrolyte imbalances, severe hypoxemia, hypoalbuminemia, cardiovascular instability and all-cause 90-day mortality.
A total of 1292 patients were included in the final evaluation, with 29.1% presenting AKI (stage 1: 31.4%, stage 2: 35.1%, stage 3: 33.5%). Multiple regression analyses show that more advanced AKI increased the risk of MAP <65 mmHg (stage 1: OR=1.833, =0.002; stage 2: OR= 4.653, <0.001; stage 3: OR=4.834, <0.001) and SBP <90 mmHg (stage 1: OR=1.644, =0.014; stage 2: OR=3.701, <0.001; stage 3: OR=5.750, <0.001), a new need for or requiring an increased dose of vasopressors (stage 1: OR=1.623, =0.014; stage 2: OR=3.250, <0.001; stage 3: OR=12.132, <0.001), gastrointestinal bleeding (stage 1: OR=1.102, =0.669; stage 2: OR=1.471, =0.060; stage 3: OR=2.377, <0.001), severe hypoxia (stage 1: OR=1.213, =0.399; stage 2: OR=1.449, =0.077; stage 3: OR=2.214, <0.001) and all-cause 90-day mortality (stage 1: OR =0.935; =0.741; stage 2: OR=1.888; =0.001; stage 3: OR=12.584; <0.001).
Our study suggests that the presence of AKI within the first 48 hours of MV in geriatric patients is associated with a higher risk for postintubation complications and 90-day mortality. Moreover, the risk of complications was greater for patients with more severe AKI.
老年患者急性肾损伤（AKI）与较高的医院死亡率相关。然而，AKI与插管周围并发症之间的关系尚不清楚。
这项回顾性、观察性、多中心队列研究纳入了2008年至2020年在中国人民解放军总医院四个医疗中心接受有创机械通气（MV）的3271例连续老年患者（≥75岁）。根据2012年KDIGO标准，在MV的前48小时内血清肌酐绝对增加≥26.5µmol/L诊断为AKI。我们记录了随后的院内并发症，包括发生胃肠道出血、新发电解质失衡、严重低氧血症、低白蛋白血症、心血管不稳定和全因90天死亡率。
共有1292例患者纳入最终评估，29.1%出现AKI（1期：31.4%，2期：35.1%，3期：33.5%）。多元回归分析显示，更严重的AKI增加了平均动脉压<65mmHg（1期：OR=1.833，P=0.002；2期：OR=4.653，P<0.001；3期：OR=4.834，P<0.001）和收缩压<90mmHg（1期：OR=1.644，P=0.014；2期：OR=3.701，P<0.001；3期：OR=5.750，P<0.001）的风险，新需要或需要增加血管升压药剂量（1期：OR=1.623，P=0.014；2期：OR=3.250，P<0.001；3期：OR=12.132，P<0.001），胃肠道出血（1期：OR=1.102，P=0.669；2期：OR=1.471，P=0.060；3期：OR=2.377，P<0.001），严重低氧血症（1期：OR=1.213，P=0.399；2期：OR=1.449，P=0.077；3期：OR=2.214，P<0.001）和全因90天死亡率（1期：OR =0.935；P=0.741；2期：OR=1.888；P=0.001；3期：OR=12.584；P<0.001）。
我们的研究表明，老年患者在MV的前48小时内出现AKI与插管后并发症和90天死亡率的较高风险相关。此外，AKI更严重的患者并发症风险更大。
