Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
Department of Critical Care Medicine, The Seventh Medical Center, Chinese PLA General Hospital, Beijing, 100700, China.
Aging Clin Exp Res. 2022 Nov;34(11):2887-2895. doi: 10.1007/s40520-022-02229-2. Epub 2022 Aug 27.
Patients who undergo mechanical ventilation (MV) are at higher risk of suffering from acute kidney injury (AKI). However, whether AKI is diagnosed in all patients and the association between AKI and mortality are unclear.
This was a retrospective, observational, multicenter cohort study conducted from January 2008 to December 2020 that included 3271 consecutive older patients (≥ 75 years) who received invasive MV from four medical centers in Chinese PLA General Hospital. AKI was diagnosed according to the serum creatinine (Scr)-based Kidney Disease: Improving Global Outcomes guidelines by an absolute increase in Scr of ≥ 26.5 µmol/L within the first 48 h of MV. The outcomes of patients with and without AKI and whether AKI was recognized were compared.
A total of 1292 patients were included in the final evaluation. Three hundred seventy-six patients (29.1%) fulfilled the diagnostic criteria. Among the 376 AKI patients, the recognition rate and nonrecognition rate were 62.8% (236/376) and 37.2% (140/376), respectively. The overall 90-day mortality rate was 45.2% (584/1,292), which was dramatically increased in unrecognized AKI patients and recognized AKI compared to non-AKI patients (70.7% vs. 54.7% vs. 38.9%, respectively, P < 0.001). The survival of patients with recognized AKI was better than that of patients with unrecognized AKI. Multivariate logistic regression analysis revealed that recognized AKI was significantly associated with mean arterial pressure, positive end-expiratory pressure, uric acid, baseline Scr, and peak Scr. AKI was identified as an independent predictor of all-cause 90-day mortality (recognized AKI vs. non-AKI: HR = 1.722; 95% CI = 1.399-2.119; P < 0.001 and unrecognized AKI vs. non-AKI: HR = 2.632; 95% CI = 2.081-3.329; P < 0.001).
AKI is a common complication in older patients undergoing MV, with substantial underdiagnosis and undertreatment. Interventions for improving the diagnosis of AKI are urgently needed.
接受机械通气（MV）的患者发生急性肾损伤（AKI）的风险更高。然而，并非所有患者都诊断出 AKI，以及 AKI 与死亡率之间的关系尚不清楚。
这是一项回顾性、观察性、多中心队列研究，纳入了来自中国人民解放军总医院的四个医学中心的 3271 例连续接受有创 MV 的老年患者（≥75 岁）。AKI 是根据血清肌酐（Scr）基于肾脏病：改善全球结局指南诊断的，MV 后 48 小时内 Scr 绝对增加≥26.5μmol/L。比较了有无 AKI 的患者的结局，以及 AKI 是否被识别。
最终有 1292 例患者纳入最终评估。376 例（29.1%）符合诊断标准。在 376 例 AKI 患者中，识别率和未识别率分别为 62.8%（236/376）和 37.2%（140/376）。总的 90 天死亡率为 45.2%（584/1292），未识别 AKI 患者和识别 AKI 患者的死亡率明显高于非 AKI 患者（分别为 70.7%、54.7%和 38.9%，P<0.001）。识别 AKI 的患者的生存情况好于未识别 AKI 的患者。多变量逻辑回归分析显示，识别 AKI 与平均动脉压、呼气末正压、尿酸、基线 Scr 和峰值 Scr 显著相关。AKI 是全因 90 天死亡率的独立预测因素（识别 AKI 与非 AKI：HR=1.722；95%CI=1.399-2.119；P<0.001 和未识别 AKI 与非 AKI：HR=2.632；95%CI=2.081-3.329；P<0.001）。
AKI 是接受 MV 的老年患者的常见并发症，存在大量漏诊和治疗不足。迫切需要采取干预措施提高 AKI 的诊断率。
