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不同KDIGO标准对非心脏手术后急性肾损伤早期识别的临床结局的影响

Impact of Different KDIGO Criteria on Clinical Outcomes for Early Identification of Acute Kidney Injury after Non-Cardiac Surgery.

作者信息

Fu Jingwen, Kosaka Junko, Morimatsu Hiroshi

机构信息

Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama 700-8558, Japan.

出版信息

J Clin Med. 2022 Sep 23;11(19):5589. doi: 10.3390/jcm11195589.

Abstract

The Kidney Disease Improving Global Outcomes (KDIGO) guidelines are currently used in acute kidney injury (AKI) diagnosis and include both serum creatinine (SCR) and urine output (UO) criteria. Currently, many AKI-related studies have inconsistently defined AKI, which possibly affects the comparison of their results. Therefore, we hypothesized that the different criteria in the KDIGO guidelines vary in measuring the incidence of AKI and its association with clinical outcomes. We retrospectively analyzed that data of patients admitted to the intensive care unit after non-cardiac surgery in 2019. Three different criteria used to define AKI were included: UOmean, mean UO < 0.5 mL/kg/h over time; UOcont, hourly UO < 0.5 mL/kg/h over time; or SCR, KDIGO guidelines SCR criteria. A total of 777 patients were included, and the incidence of UOmean-AKI was 33.1%, the incidence of UOcont-AKI was 7.9%, and the incidence of SCR-AKI was 2.0%. There were differences in the length of ICU stay and hospital stay between AKI and non-AKI patients under different criteria. We found differences in the incidence and clinical outcomes of AKI after non-cardiac surgery when using different KDIGO criteria.

摘要

改善全球肾脏病预后组织(KDIGO)指南目前用于急性肾损伤(AKI)的诊断,包括血清肌酐(SCR)和尿量(UO)标准。目前,许多与AKI相关的研究对AKI的定义不一致,这可能会影响其结果的比较。因此,我们推测KDIGO指南中的不同标准在测量AKI的发生率及其与临床结局的关联方面存在差异。我们回顾性分析了2019年非心脏手术后入住重症监护病房的患者数据。纳入了三种用于定义AKI的不同标准:平均尿量(UOmean),即平均每小时尿量<0.5 mL/kg;持续尿量(UOcont),即每小时尿量<0.5 mL/kg;或SCR,即KDIGO指南中的SCR标准。共纳入777例患者,平均尿量定义的AKI(UOmean-AKI)发生率为33.1%,持续尿量定义的AKI(UOcont-AKI)发生率为7.9%,SCR定义的AKI(SCR-AKI)发生率为2.0%。不同标准下,AKI患者与非AKI患者在重症监护病房住院时间和住院时间上存在差异。我们发现,使用不同的KDIGO标准时,非心脏手术后AKI的发生率和临床结局存在差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/11ad/9571209/122a32a4fc4b/jcm-11-05589-g001.jpg

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