Critical Care Program, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Kensington, NSW, Australia.
Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.
Crit Care Med. 2024 Aug 1;52(8):1264-1274. doi: 10.1097/CCM.0000000000006284. Epub 2024 Apr 1.
To derive a pooled estimate of the incidence and outcomes of sepsis-associated acute kidney injury (SA-AKI) in ICU patients and to explore the impact of differing definitions of SA-AKI on these estimates.
Medline, Medline Epub, EMBASE, and Cochrane CENTRAL between 1990 and 2023.
Randomized clinical trials and prospective cohort studies of adults admitted to the ICU with either sepsis and/or SA-AKI.
Data were extracted in duplicate. Risk of bias was assessed using adapted standard tools. Data were pooled using a random-effects model. Heterogeneity was assessed by using a single covariate logistic regression model. The primary outcome was the proportion of participants in ICU with sepsis who developed AKI.
A total of 189 studies met inclusion criteria. One hundred fifty-four reported an incidence of SA-AKI, including 150,978 participants. The pooled proportion of patients who developed SA-AKI across all definitions was 0.40 (95% CI, 0.37-0.42) and 0.52 (95% CI, 0.48-0.56) when only the Risk Injury Failure Loss End-Stage, Acute Kidney Injury Network, and Improving Global Outcomes definitions were used to define SA-AKI. There was significant variation in the incidence of SA-AKI depending on the definition of AKI used and whether AKI defined by urine output criteria was included; the incidence was lowest when receipt of renal replacement therapy was used to define AKI (0.26; 95% CI, 0.24-0.28), and highest when the Acute Kidney Injury Network score was used (0.57; 95% CI, 0.45-0.69; p < 0.01). Sixty-seven studies including 29,455 participants reported at least one SA-AKI outcome. At final follow-up, the proportion of patients with SA-AKI who had died was 0.48 (95% CI, 0.43-0.53), and the proportion of surviving patients who remained on dialysis was 0.10 (95% CI, 0.04-0.17).
SA-AKI is common in ICU patients with sepsis and carries a high risk of death and persisting kidney impairment. The incidence and outcomes of SA-AKI vary significantly depending on the definition of AKI used.
得出 ICU 患者脓毒症相关性急性肾损伤（SA-AKI）的发病率和结局的汇总估计，并探讨不同的 SA-AKI 定义对这些估计的影响。
1990 年至 2023 年间的 Medline、Medline Epub、EMBASE 和 Cochrane CENTRAL。
纳入 ICU 收治的脓毒症和/或 SA-AKI 成人的随机临床试验和前瞻性队列研究。
数据由两人重复提取。使用改编的标准工具评估偏倚风险。使用随机效应模型汇总数据。使用单变量逻辑回归模型评估异质性。主要结局是 ICU 中患有脓毒症的参与者中发生 AKI 的比例。
共有 189 项研究符合纳入标准。其中 154 项报告了 SA-AKI 的发生率，包括 150978 名参与者。所有定义的 SA-AKI 患者的总体发生率为 0.40（95%CI，0.37-0.42），仅使用 Risk Injury Failure Loss End-Stage、急性肾损伤网络和改善全球结局定义时为 0.52（95%CI，0.48-0.56）。SA-AKI 的发生率因 AKI 定义的不同以及是否包括尿量标准定义的 AKI 而有显著差异；当使用肾脏替代疗法定义 AKI 时，发生率最低（0.26；95%CI，0.24-0.28），当使用急性肾损伤网络评分时，发生率最高（0.57；95%CI，0.45-0.69；p<0.01）。67 项研究包括 29455 名参与者，报告了至少一个 SA-AKI 结局。在最终随访时，SA-AKI 患者的死亡率为 0.48（95%CI，0.43-0.53），存活患者继续透析的比例为 0.10（95%CI，0.04-0.17）。
脓毒症 ICU 患者中 SA-AKI 很常见，死亡率和持续的肾脏损害风险很高。SA-AKI 的发生率和结局因使用的 AKI 定义而异。
