Department of Urology, Hirosaki University Graduate School of Medicine, 5-Zaifucho, Hirosaki, 036-8562, Japan.
Department of Urology, Mutsu General Hospital, Mutsu, Japan.
World J Urol. 2024 May 8;42(1):301. doi: 10.1007/s00345-024-05018-w.
To evaluate the impact of severe acute kidney injury (AKI) on short-term mortality in patients with urosepsis.
This prospective cohort study evaluated 207 patients with urosepsis. AKI was diagnosed in accordance with the Kidney Disease Improving Global Outcomes criteria, and severe AKI was defined as stage 2 or 3 AKI. Patients were divided into two groups: patients who developed severe AKI (severe AKI group) and patients who did not (control group). The primary endpoint was all-cause mortality within 30 days. The secondary endpoints were 90-day mortality and in-hospital mortality. The exploratory outcomes were the risk factors for severe AKI development.
The median patient age was 79 years. Of the 207 patients, 56 (27%) developed severe AKI. The 30-day mortality rate in the severe AKI group was significantly higher than that in the control group (20% vs. 2.0%, respectively; P < 0.001). In the multivariable analysis, performance status and severe AKI were significantly associated with 30-day mortality. The in-hospital mortality and 90-day mortality rates in the severe AKI group were significantly higher than those in the control group (P < 0.001 and P < 0.001, respectively). In the multivariable analysis, age, urolithiasis-related sepsis, lactate values, and disseminated intravascular coagulation were significantly associated with severe AKI development.
Severe AKI was a common complication in patients with urosepsis and contributed to high short-term mortality rates.
评估严重急性肾损伤（AKI）对尿脓毒症患者短期死亡率的影响。
本前瞻性队列研究评估了 207 例尿脓毒症患者。AKI 按照肾脏病改善全球结局（KDIGO）标准诊断，严重 AKI 定义为 2 或 3 期 AKI。患者分为两组：发生严重 AKI 的患者（严重 AKI 组）和未发生严重 AKI 的患者（对照组）。主要终点为 30 天内全因死亡率。次要终点为 90 天死亡率和住院死亡率。探索性结局为严重 AKI 发生的危险因素。
患者中位年龄为 79 岁。207 例患者中，56 例（27%）发生严重 AKI。严重 AKI 组 30 天死亡率明显高于对照组（分别为 20%和 2.0%；P<0.001）。多变量分析显示，一般状况和严重 AKI 与 30 天死亡率显著相关。严重 AKI 组的住院死亡率和 90 天死亡率明显高于对照组（均 P<0.001）。多变量分析显示，年龄、与尿石症相关的脓毒症、乳酸值和弥散性血管内凝血与严重 AKI 的发生显著相关。
严重 AKI 是尿脓毒症患者的常见并发症，导致短期死亡率高。
