Xiao Yangchun, Wan Jun, Zhang Yu, Wang Xing, Zhou Hanwen, Lai Han, Chong Weelic, Hai Yang, Lunsford L Dade, You Chao, Yu Shui, Fang Fang
Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, China.
Key Laboratory of Pattern Recognition and Intelligent Information Processing, Institutions of Higher Education of Sichuan Province, Chengdu University, Chengdu, China.
Front Neurol. 2022 Sep 1;13:864193. doi: 10.3389/fneur.2022.864193. eCollection 2022.
Though acute kidney injury (AKI) in the context of aneurysmal subarachnoid hemorrhage (aSAH) worsens short-term outcomes, its impact on long-term survival is unknown.
We aimed to evaluate the association between long-term mortality and AKI during hospitalization for aSAH.
This was a retrospective study of patients who survived >12 months after aSAH. All patients were evaluated at West China Hospital, Sichuan University, between December 2013 and June 2019. The minimum follow-up time was over 1 year. the maximum follow-up time was about 7.3 years. AKI was defined by the KDIGO (The Kidney Disease Improving Global Outcomes) guidelines, which stratifies patients into three stages of severity. The primary outcome was long-term mortality, which was analyzed with Kaplan-Meier curves and Cox proportional hazards models.
During this study period, 238 (9.2%) patients had AKI among 2,592 patients with aSAH. We confirmed that AKI during care for aSAH significantly increased long-term mortality (median 4.3 years of follow-up) and that risk increased with the severity of the kidney failure, with an adjusted hazard ratio (HR) of 2.08 (95% CI 1.49-2.89) for stage 1 AKI, 2.15 (95% CI 1.05-4.43) for stage 2 AKI, and 2.66 (95% CI 1.08-6.53) for stage 3 AKI compared with patients without AKI. Among patients with an AKI episode, those with renal recovery still had increased long-term mortality (HR 1.96; 95% CI 1.40-2.74) compared with patients without AKI but had better long-term outcomes than those without renal recovery (HR 0.51, 95% CI 0.27-0.97).
Among 12-month survivors of aSAH, AKI during their initial hospitalization for aSAH was associated with increased long-term mortality, even for patients who had normal renal function at the time of hospital discharge. Longer, multidisciplinary post-discharge follow-up may be warranted for these patients.
尽管动脉瘤性蛛网膜下腔出血（aSAH）患者发生的急性肾损伤（AKI）会使短期预后恶化，但其对长期生存的影响尚不清楚。
我们旨在评估aSAH住院期间长期死亡率与AKI之间的关联。
这是一项对aSAH存活超过12个月患者的回顾性研究。所有患者于2013年12月至2019年6月在四川大学华西医院接受评估。最短随访时间超过1年，最长随访时间约7.3年。AKI依据KDIGO（改善全球肾脏病预后组织）指南定义，该指南将患者分为三个严重程度阶段。主要结局为长期死亡率，采用Kaplan-Meier曲线和Cox比例风险模型进行分析。
在本研究期间，2592例aSAH患者中有238例（9.2%）发生AKI。我们证实，aSAH治疗期间的AKI显著增加长期死亡率（中位随访4.3年），且风险随肾衰竭严重程度增加，与无AKI的患者相比，1期AKI的校正风险比（HR）为2.08（95%CI 1.49 - 2.89），2期AKI为2.15（95%CI 1.05 - 4.43），3期AKI为2.66（95%CI 1.08 - 6.53）。在发生过AKI的患者中，肾功能恢复的患者与无AKI的患者相比，长期死亡率仍增加（HR 1.96；95%CI 1.40 - 2.74），但比肾功能未恢复的患者长期预后更好（HR 0.51，95%CI 0.27 - 0.97）。
在aSAH的12个月幸存者中，aSAH初次住院期间的AKI与长期死亡率增加相关，即使是出院时肾功能正常的患者。对于这些患者，出院后可能需要进行更长时间的多学科随访。
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