Li Qinglin, Wang Yan, Zhou Feihu
Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
Department of Cardiology, The Second Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
J Intensive Med. 2023 May 6;3(3):283-290. doi: 10.1016/j.jointm.2023.02.004. eCollection 2023 Jul 31.
Acute kidney injury (AKI) is primarily defined and classified according to the magnitude of the elevation of serum creatinine (Scr). We aimed to determine whether the duration of AKI adds prognostic value in addition to that obtained from the magnitude of injury alone.
This retrospective study enrolled very elderly inpatients (≥75 years) in the Chinese PLA General Hospital from January 2007 to December 2018. AKI was stratified by magnitude according to KDIGO stage (1, 2, and 3) and duration (1-2 days, 3-4 days, 5-7 days, and >7 days). The primary outcome was the 1-year mortality after AKI. Multivariable Cox regression analysis was performed to identify covariates associated with the 1-year mortality. The probability of survival was estimated using the Kaplan-Meier method, and curves were compared using the log-rank test.
In total, 688 patients were enrolled, with the median age was 88 (84-91) years, and the majority (652, 94.8%) were male. According to the KDIGO criteria, 317 patients (46.1%) had Stage 1 AKI, 169 (24.6%) had Stage 2 AKI, and 202 (29.3%) had Stage 3 AKI. Of the 688 study subjects, 61 (8.9%) with a duration of AKI lasted 1-2 days, 104 (15.1%) with a duration of AKI lasted 3-4 days, 140 (20.3%) with a duration of AKI lasted 5-7 days, and 383 (55.7%) with a duration of AKI lasted >7 days. Within each stage, a longer duration of AKI was slightly associated with a higher rate of 1-year mortality. However, within each of the duration categories, the stage of AKI was significantly associated with 1-year mortality. When considered separately in multivariate analyses, both the duration of AKI (3-4 days: HR=3.184; 95% CI: 1.733-5.853; <0.001, 5-7 days: HR=1.915; 95% CI: 1.073-3.416; =0.028; >7 days: HR=1.766; 95% CI: 1.017-3.065; =0.043) and more advanced AKI stage (Stage 2: HR=3.063; 95% CI: 2.207-4.252; <0.001; Stage 3: HR=7.333; 95% CI: 5.274-10.197; <0.001) were independently associated with an increased risk of 1-year mortality.
In very elderly AKI patients, both a higher stage and duration were independently associated with an increased risk of 1-year mortality. Hence, the duration of AKI adds additional information to predict long-term mortality.
急性肾损伤（AKI）主要根据血清肌酐（Scr）升高的幅度进行定义和分类。我们旨在确定AKI的持续时间除了从损伤幅度单独获得的信息外，是否还能增加预后价值。
这项回顾性研究纳入了2007年1月至2018年12月在中国人民解放军总医院住院的高龄患者（≥75岁）。AKI根据KDIGO分期（1、2和3期）和持续时间（1 - 2天、3 - 4天、5 - 7天和>7天）进行分层。主要结局是AKI后1年的死亡率。进行多变量Cox回归分析以确定与1年死亡率相关的协变量。使用Kaplan - Meier方法估计生存概率，并使用对数秩检验比较曲线。
总共纳入了688例患者，中位年龄为88（84 - 91）岁，大多数（652例，94.8%）为男性。根据KDIGO标准，317例患者（46.1%）患有1期AKI，169例（24.6%）患有2期AKI，202例（29.3%）患有3期AKI。在688例研究对象中，61例（8.9%）AKI持续时间为1 - 2天，104例（15.1%）AKI持续时间为3 - 4天，140例（20.3%）AKI持续时间为5 - 7天，383例（55.7%）AKI持续时间>7天。在每个分期内，AKI持续时间较长与1年死亡率较高略有相关。然而，在每个持续时间类别中，AKI分期与1年死亡率显著相关。在多变量分析中分别考虑时，AKI的持续时间（3 - 4天：HR = 3.184；95%CI：1.733 - 5.853；<0.001，5 - 7天：HR = 1.915；95%CI：1.073 - 3.416；= 0.028；>7天：HR = 1.766；95%CI：1.017 - 3.065；= 0.043）和更高级别的AKI分期（2期：HR = 3.063；95%CI：2.207 - 4.252；<0.001；3期：HR = 7.333；95%CI：5.274 - 10.197；<0.001）均与1年死亡风险增加独立相关。
在高龄AKI患者中，更高的分期和持续时间均与1年死亡风险增加独立相关。因此，AKI的持续时间为预测长期死亡率增加了额外信息。
