Kim June-Sung, Kim Ye-Jee, Kim Youn-Jung, Kim Won Young
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea.
Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea.
Cancers (Basel). 2023 Jul 14;15(14):3619. doi: 10.3390/cancers15143619.
(1) Background: Considering recent advances in both cancer and sepsis management, we chose to evaluate the associated factors for occurrence of septic acute kidney injury in cancer patients using a nationwide population-based cohort data. (2) Methods: Using data from the National Health Insurance Service of Korea, adult cancer patients who presented to emergency departments with septic shock from 2009 to 2017 were analyzed. A Cox-proportional hazard model was conducted to evaluate the clinical effect of sepsis-related acute kidney injury requiring dialysis. (3) Results: Among 42,477 adult cancer patients with septic shock, dialysis-requiring acute kidney injury occurred in 5449 (12.8%). Recovery from dialysis within 30 days was 77.9% and, overall, 30-day and 2-year mortality rates were 52.1% and 85.1%, respectively. Oncologic patients with dialysis-requiring acute kidney injury frequently occurred in males and patients with hematologic cancer. A multivariate Cox-proportional hazard model showed that dialysis-requiring acute kidney injury had the highest adjusted hazard ratio of 1.353 (95% confidence interval 1.313-1.395) for 2-year mortality. (4) Conclusions: Dialysis-requiring septic acute kidney injury did not occur commonly. However, it had a significant association with increased long-term mortality, which suggests emphasis should be placed on the prevention of acute kidney injury, particularly in male hematologic cancer patients.
(1) 背景：鉴于癌症和脓毒症治疗方面的最新进展，我们选择使用全国基于人群的队列数据来评估癌症患者发生脓毒症性急性肾损伤的相关因素。(2) 方法：利用韩国国民健康保险服务的数据，对2009年至2017年因脓毒症休克就诊于急诊科的成年癌症患者进行分析。采用Cox比例风险模型评估需要透析的脓毒症相关急性肾损伤的临床效果。(3) 结果：在42477例患有脓毒症休克的成年癌症患者中，5449例（12.8%）发生了需要透析的急性肾损伤。30天内透析恢复率为77.9%，总体而言，30天和2年死亡率分别为52.1%和85.1%。需要透析的急性肾损伤在男性和血液系统癌症患者中更为常见。多变量Cox比例风险模型显示，需要透析的急性肾损伤对2年死亡率的调整后风险比最高为 (1.353)（95%置信区间 (1.313 - 1.395)）。(4) 结论：需要透析的脓毒症性急性肾损伤并不常见。然而，它与长期死亡率增加显著相关，这表明应重视急性肾损伤的预防，特别是在男性血液系统癌症患者中。
