[脓毒症相关急性肾损伤发病时间与脓毒症患者临床结局的相关性]

[Association between onset time of sepsis-associated acute kidney injury and clinical outcome in patients with sepsis].

作者信息

Wang N, Wang M P, Jiang L, Lou R, Su W X, Zhu B, Xi X M

机构信息

Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.

Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2024 Jun 4;104(21):1972-1978. doi: 10.3760/cma.j.cn112137-20231030-00940.

DOI:10.3760/cma.j.cn112137-20231030-00940

PMID:38825940

Abstract

To explore the relationship between the onset time of sepsis-associated acute kidney injury (SA-AKI) and adverse clinical outcomes. Data were derived from Beijing Acute Kidney Injure Trial (BAKIT) which investigated the epidemiology of acute kidney injury (AKI) in critically ill patients at 30 intensive care units (ICU) of 28 tertiary hospitals in Beijing from 1 March to 31 August 2012. Patients who were older than 18 years and diagnosed with sepsis and AKI, and expected to stay in ICU for at least 24 h were included in this study. A total of 653 patients were included in this study, 414 males and 239 females with a mean age of (68.2±17.0) years. According to the onset time of SA-AKI, patients were grouped into early AKI (E-AKI) (AKI occurred within 48 hours after ICU admission) and late AKI (L-AKI) (AKI occurred after 48 hours of ICU admission) group. The primary outcome was major adverse kidney events (MAKE), consisted of all-cause mortality, renal replacement therapy-dependence, and an inability to recover to 1.5 times of the baseline creatinine value up to 30 days. Multivariable logistic regression was used to investigate the association between the onset time of SA-AKI and clinical outcomes. A total of 653 patients with SA-AKI were included, 423 (64.8%) patients developed E-AKI, 230 (35.2%) cases developed L-AKI, MAKE occurred in 405 (62.0%) cases, and 301 (46.1%) patients died in hospital. Compared with E-AKI group, L-AKI patients showed higher AKI 3 level rate [55.7%(128/230) vs 40.2%(170/423), <0.001], incidence of MAKE [72.6%(167/230) vs 56.3%(238/423,<0.001)] and hospital mortality [55.2%(127/230) vs 44.1%(174/423), =0.001]. The risk of MAKE and in-hospital mortality in L-AKI group increased for 2.55-fold times (=3.55, 95%: 1.94-6.04) and 1.84-fold times (=2.84, 95%: 1.44-5.60) when compared with those in E-AKI, respectively (both <0.05). Late timing onset of SA-AKI is associated with poor clinical outcomes.

摘要

探讨脓毒症相关性急性肾损伤（SA-AKI）发病时间与不良临床结局之间的关系。数据来源于北京急性肾损伤试验（BAKIT），该试验于2012年3月1日至8月31日在北京28家三级医院的30个重症监护病房（ICU）调查重症患者急性肾损伤（AKI）的流行病学情况。本研究纳入年龄大于18岁、诊断为脓毒症和AKI且预计在ICU至少停留24小时的患者。本研究共纳入653例患者，其中男性414例，女性239例，平均年龄为（68.2±17.0）岁。根据SA-AKI的发病时间，患者被分为早期AKI（E-AKI）组（AKI发生在入住ICU后48小时内）和晚期AKI（L-AKI）组（AKI发生在入住ICU 48小时后）。主要结局为主要不良肾脏事件（MAKE），包括全因死亡率、肾脏替代治疗依赖以及至30天时肌酐值无法恢复至基线值的1.5倍。采用多变量logistic回归分析探讨SA-AKI发病时间与临床结局之间的关联。共纳入653例SA-AKI患者，423例（64.8%）发生E-AKI，230例（35.2%）发生L-AKI，405例（62.0%）发生MAKE，301例（46.1%）患者住院死亡。与E-AKI组相比，L-AKI患者的AKI 3级发生率更高[55.7%（128/230）对40.2%（170/423），<0.001]，MAKE发生率更高[72.6%（167/230）对56.3%（238/423，<0.001]，住院死亡率更高[55.2%（127/230）对44.1%（174/423），=0.001]。与E-AKI组相比，L-AKI组MAKE和住院死亡率的风险分别增加2.55倍（=3.55，95%：1.94 - 6.04）和1.84倍（=2.84，95%：1.44 - 5.60）（均<0.05）。SA-AKI发病时间较晚与不良临床结局相关。