Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Department of Nephrology, Pak Emirates Military Hospital, Rawalpindi, Pakistan.
Saudi J Kidney Dis Transpl. 2021 Nov-Dec;32(6):1736-1743. doi: 10.4103/1319-2442.352436.
Acute kidney injury (AKI) is associated with high mortality and morbidity risk. Factors predictive of mortality can guide in early identification of high-risk patients and escalation of therapy to improve outcomes. There is a paucity of data on AKI in Pakistan, and this study was done to determine in-hospital AKI mortality and the associated predictors of mortality. This was a prospective observational study conducted in the Acute Medical Unit and High Dependency Unit of Pak Emirates Military Hospital, Rawalpindi, from June to December 2018. Based on the Kidney Disease Improving Global Outcomes (KDIGO) AKI definition, 130 critically ill patients were included, while patients with chronic kidney disease were excluded. Data were collected on demographic profile-morbid conditions, etiology, laboratory values, and outcomes. The overall mortality was 45.4% (59/130) and varied with the stage of AKI, as it was 21.6%, 36.0%, and 61.8% in KDIGO stages 1, 2, and 3, respectively (P <0.05). There was a significant association (P <0.001) between sepsis, age >65 years, and mortality. Patients with inhospital mortality had higher median serum creatinine and mean potassium levels (P <0.01), with lower mean sodium levels and bicarbonate levels <10 mmol/L. However, on multivariate analysis using variables age >65 years, AKI stage 3, oliguria, bicarbonate <10 mmol/L, and sodium levels <130 mmol/L, only age [odds ratio (OR): 3.16, confidence interval (CI) 95%: 1.40-7.15), AKI stage 3 (OR: 3.12, CI 95%: 1.32-7.38], and low sodium levels <130 mmol/L (OR: 4.52, CI 95%: 1.40-14.61) were found to be independent predictors of mortality. Diabetes mellitus need for vasopressors, oliguria, hemodialysis requirement, and mean leukocyte counts had no significant association with mortality. AKI was associated with high in-hospital mortality in critically ill patients. Sepsis, hypertension, older age, Stage 3 AKI, higher mean creatinine, and potassium were predictive of increased mortality risk.
急性肾损伤 (AKI) 与高死亡率和高发病率风险相关。预测死亡率的因素可以指导早期识别高危患者，并升级治疗以改善预后。巴基斯坦缺乏 AKI 相关数据，本研究旨在确定住院 AKI 死亡率和相关死亡率预测因素。这是一项前瞻性观察研究，于 2018 年 6 月至 12 月在拉瓦尔品第的 Pak Emirates 军事医院的急性内科病房和高依赖病房进行。根据肾脏疾病改善全球结果 (KDIGO) AKI 定义，纳入了 130 名危重症患者，而排除了慢性肾脏病患者。收集了人口统计学特征-合并症、病因、实验室值和结局的数据。总体死亡率为 45.4%（59/130），并随 AKI 分期而变化，KDIGO 分期 1、2 和 3 分别为 21.6%、36.0%和 61.8%（P<0.05）。败血症、年龄>65 岁与死亡率之间存在显著相关性（P<0.001）。住院期间死亡患者的血清肌酐中位数和平均钾水平较高（P<0.01），平均钠水平和碳酸氢盐水平<10mmol/L。然而，使用年龄>65 岁、AKI 分期 3、少尿、碳酸氢盐<10mmol/L 和钠水平<130mmol/L 等变量进行多变量分析时，只有年龄[比值比（OR）：3.16，95%置信区间（CI）：1.40-7.15]、AKI 分期 3（OR：3.12，CI 95%：1.32-7.38]和低钠水平<130mmol/L（OR：4.52，CI 95%：1.40-14.61）被发现是死亡率的独立预测因素。糖尿病、需要血管加压素、少尿、需要血液透析和平均白细胞计数与死亡率无显著相关性。AKI 与危重症患者住院期间高死亡率相关。败血症、高血压、年龄较大、AKI 分期 3、较高的平均肌酐和钾与增加的死亡风险相关。
