Internal Medicine Residency Program, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
ICU, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China.
J Nephrol. 2023 May;36(4):1037-1046. doi: 10.1007/s40620-022-01558-9. Epub 2023 Jan 24.
The relationship between the lung and kidney investigated in animal and clinical models has demonstrated substantial crosstalk. We aimed to evaluate the association between single vs. concurrent AKI and ARDS and its impact on patient outcomes. Secondly, we aimed to assess whether the order of appearance of these pathologies affected patient outcomes in patients with both diseases.
This single-center retrospective cohort study included adult patients admitted to the ICU from January 1, 2007 through May 1, 2018 (n = 76,988). Baseline characteristics and outcomes were compared among patients without ARDS or AKI and those with one or both ARDS and AKI. We also assessed outcomes across the order of appearance of these diseases among patients with both AKI and ARDS.
We enrolled 76,988 unique patients in the final analysis: 47,043 patients with neither AKI nor ARDS, 491 patients with ARDS alone, 27,928 patients with AKI alone, and 1,526 patients with both ARDS and AKI. Patients with both ARDS and AKI had higher ICU (21.2%) and hospital (28.4%) mortality compared to patients with ARDS alone (9.0% ICU mortality, 14.0% hospital mortality) or AKI alone (4.4% ICU mortality, 8.4% hospital mortality) (p < 0.001). These findings remained unchanged after adjusting for illness severity and comorbidities. Of the 1136 patients with both AKI and ARDS, 136 (12%) developed AKI first, 303 (27%) ARDS first, and 697 (61%) had simultaneous diseases. Patients who developed ARDS after AKI had significantly increased ICU (29.4%) and hospital (36.8%) mortality compared to patients who developed AKI after ARDS (13.9% ICU mortality, 21.5% hospital mortality) (p < 0.001).
The combination of AKI and ARDS leads to worse outcomes, including longer hospital and ICU lengths of stay, higher mortality, longer kidney replacement therapy, and longer ventilation requirements than in patients with AKI or ARDS alone. Among patients with both diagnoses, those who developed ARDS after AKI had the highest mortality.
在动物和临床模型中研究肺与肾之间的关系表明两者之间存在大量的相互作用。本研究旨在评估急性肾损伤（AKI）和急性呼吸窘迫综合征（ARDS）单一或同时出现与患者结局的关系，及其对患者结局的影响。其次，我们旨在评估这些病理的出现顺序是否会影响同时患有这两种疾病患者的结局。
本单中心回顾性队列研究纳入了 2007 年 1 月 1 日至 2018 年 5 月 1 日期间入住 ICU 的成年患者（n=76988）。比较无 ARDS 或 AKI 患者与存在 ARDS 或 AKI 单一疾病或 ARDS 和 AKI 两种疾病患者的基线特征和结局。我们还评估了同时患有 AKI 和 ARDS 的患者中这些疾病出现顺序对结局的影响。
最终纳入了 76988 例患者进行分析：47043 例患者既无 AKI 也无 ARDS，491 例患者仅有 ARDS，27928 例患者仅有 AKI，1526 例患者同时患有 ARDS 和 AKI。与仅有 ARDS 患者（ICU 死亡率 9.0%，住院死亡率 14.0%）或仅有 AKI 患者（ICU 死亡率 4.4%，住院死亡率 8.4%）相比，同时患有 ARDS 和 AKI 的患者 ICU（21.2%）和住院（28.4%）死亡率更高（p<0.001）。调整疾病严重程度和合并症后，这些发现仍然不变。在 1136 例同时患有 AKI 和 ARDS 的患者中，136 例（12%）先发生 AKI，303 例（27%）先发生 ARDS，697 例（61%）同时发生两种疾病。与先发生 ARDS 后发生 AKI 的患者相比（ICU 死亡率 13.9%，住院死亡率 21.5%），先发生 AKI 后发生 ARDS 的患者 ICU（29.4%）和住院（36.8%）死亡率显著增加（p<0.001）。
与仅患有 AKI 或 ARDS 的患者相比，AKI 和 ARDS 的合并会导致更差的结局，包括更长的住院和 ICU 住院时间、更高的死亡率、更长的肾脏替代治疗时间和更长的通气需求。在同时患有这两种疾病的患者中，先发生 AKI 后发生 ARDS 的患者死亡率最高。
