III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Centre for Medical Sciences - CISMed, University of Trento, Via S. Maria Maddalena 1, 38122 Trento, Italy; Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Italy.
Eur J Intern Med. 2024 Sep;127:119-125. doi: 10.1016/j.ejim.2024.05.007. Epub 2024 May 14.
The increasing admissions of very elderly patients to intensive care units (ICUs) over recent decades highlight a growing need for understanding acute kidney injury (AKI) in this population. Although these individuals are potentially at high risk for AKI and adverse outcomes, data on AKI in this population is scarce. This study investigates the AKI incidence and outcomes of critically-ill patients aging at least 90 years.
This retrospective cohort study conducted at the Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Germany (2008-2020), investigates AKI incidence and outcomes between 2008 and 2020 in critically-ill patients aged ≥ 90 years. AKI was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria using creatinine dynamics and/or urine output. Primary endpoint was overall mortality after 1 year. Secondary endpoints were in-hospital mortality, length of ICU and hospital stay.
During the study period 92,958 critically-ill patients were treated and 1108 were ≥ 90 years. Of these, 1054 patients had available creatinine values and were included in the present study. AKI occurred in 24.4%, mostly classified as mild (17.5%). AKI was independently associated with a significant increase in overall mortality (HR 1.21, 95 %-CI: 1.01-1.46), in-hospital mortality (OR 2, 1.41-2.85), length of ICU (+2.8 days, 2.3-3.3) and hospital stay (+2.3 days, 0.9-3.7). Severity escalated these effects, but even mild AKI showed significance. Introducing urine-based criteria increased incidence but compromised mortality prediction.
AKI is a frequent complication in very elderly critically-ill patients. Occurrence of AKI at any stage was associated with increased mortality. Predictive ability applied to AKI defined by creatinine but not urine output. Careful attention of creatinine dynamics is essential in very elderly ICU-patients.
近几十年来，重症监护病房（ICU）收治的超高龄患者不断增加，这突显了人们对该人群急性肾损伤（AKI）的认识不断提高的需求。尽管这些人发生 AKI 和不良预后的风险较高，但关于该人群 AKI 的数据却很少。本研究旨在调查年龄至少 90 岁的重症患者 AKI 的发生率和结局。
本研究为回顾性队列研究，在德国汉堡埃彭多夫大学医学中心重症监护医学系进行（2008-2020 年），调查了 2008 年至 2020 年期间年龄≥90 岁的重症患者 AKI 的发生率和结局。AKI 定义依据肾脏疾病：改善全球预后（KDIGO）标准，使用肌酐动力学和/或尿量。主要终点为 1 年后的总死亡率。次要终点为院内死亡率、ICU 住院时间和住院时间。
研究期间共治疗了 92958 名重症患者，其中 1108 名患者年龄≥90 岁。这些患者中，有 1054 名患者的肌酐值可用，被纳入本研究。AKI 发生率为 24.4%，主要为轻度（17.5%）。AKI 与总死亡率显著增加（HR 1.21，95%CI：1.01-1.46）、院内死亡率（OR 2，1.41-2.85）、ICU 住院时间（+2.8 天，2.3-3.3）和住院时间（+2.3 天，0.9-3.7）增加独立相关。严重程度加重了这些影响，但即使是轻度 AKI 也具有统计学意义。采用基于尿液的标准会增加 AKI 的发生率，但会影响死亡率的预测。
AKI 是高龄重症患者的常见并发症。AKI 的发生与死亡率增加有关。应用于 AKI 定义的肌酐而不是尿液输出的预测能力。在高龄 ICU 患者中，应仔细关注肌酐动力学。
