Division of Urology, Acre Federal University, Rio Branco, Acre, Brazil.
Laboratório de Investigação (LIM) 12, Serviço de Nefrologia, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.
Sci Rep. 2024 Oct 3;14(1):22954. doi: 10.1038/s41598-024-74177-y.
The Brazilian Amazon is a vast area with limited health care resources. To assess the epidemiology of critically ill acute kidney injury (AKI) patients in this area, a prospective cohort study of 1029 adult patients of the three intensive care units (ICUs) of Rio Branco city, the capital of Acre state, were evaluated from February 2014 to February 2016. The incidence of AKI was 53.3%. Risk factors for AKI included higher age, nonsurgical patients, admission to the ICU from the ward, higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores at ICU admission, and positive fluid balance > 1500 ml/24 hours in the days before AKI development in the ICU, with aOR of 1.3 (95% CI 1.03-1.23), 1.47 (95% CI 1.07-2.03), 1.96 (95% CI 1.40-2.74), 1.05 (95% CI 1.03-1.08) for each unit increase, and 1.62 (95% CI 1.16-2.26), respectively. AKI was associated with higher ICU mortality (aOR 2.03, 95% CI 1.29-3.18). AKI mortality was independently associated with higher age, nonsurgical patients, sepsis at ICU admission, presence of shock or use of vasoactive drugs, mechanical ventilation and mean positive fluid balance in the ICU > 1500 ml/24 hours, both during ICU follow-up, with aOR 1.27 (95% CI 1.14-1.43) for each 10-year increase, 1.64 (95% CI 1.07-2.52), 2.35 (95% CI 1.14-4.83), 1.88 (95% CI 1.03-3.44), 6.73 (95% CI 4.08-11.09), 2.31 (95% CI 1.52-3.53), respectively. Adjusted hazard ratios for AKI mortality 30 and 31-180 days after ICU discharge were 3.13 (95% CI 1.84-5.31) and 1.69 (95% CI 0.99-2.90), respectively. AKI incidence was strikingly high among critically ill patients in the Brazilian Amazon. The AKI etiology, risk factors and outcomes were similar to those described in high-income countries, but mortality rates were higher.
巴西亚马孙地区是一个地域辽阔但医疗资源有限的地区。为了评估该地区重症急性肾损伤（AKI）患者的流行病学情况，对 2014 年 2 月至 2016 年 2 月期间来自阿克州首府里奥布兰科市 3 个重症监护病房（ICU）的 1029 名成年患者进行了前瞻性队列研究。AKI 的发病率为 53.3%。AKI 的危险因素包括年龄较大、非手术患者、从病房转入 ICU、入 ICU 时急性生理学和慢性健康评估（APACHE）Ⅱ评分较高，以及 ICU 内 AKI 发展前的 1500ml/24 小时内液体正平衡>1500ml，比值比（aOR）分别为 1.3（95%可信区间 1.03-1.23）、1.47（95%可信区间 1.07-2.03）、1.96（95%可信区间 1.40-2.74）、1.05（95%可信区间 1.03-1.08）、1.62（95%可信区间 1.16-2.26）。AKI 与 ICU 死亡率升高相关（aOR 2.03，95%可信区间 1.29-3.18）。AKI 死亡率与年龄较大、非手术患者、ICU 入院时脓毒症、休克或血管活性药物使用、机械通气和 ICU 内液体正平衡>1500ml/24 小时有关，且 ICU 随访期间两者均呈正相关，每增加 10 岁，aOR 为 1.27（95%可信区间 1.14-1.43）、1.64（95%可信区间 1.07-2.52）、2.35（95%可信区间 1.14-4.83）、1.88（95%可信区间 1.03-3.44）、6.73（95%可信区间 4.08-11.09）、2.31（95%可信区间 1.52-3.53）。ICU 出院后 30 天和 31-180 天 AKI 死亡率的调整后危险比分别为 3.13（95%可信区间 1.84-5.31）和 1.69（95%可信区间 0.99-2.90）。巴西亚马孙地区重症患者 AKI 的发病率非常高。AKI 的病因、危险因素和结局与高收入国家相似，但死亡率更高。
