Li Qinglin, Li Guanggang, Li Dawei, Chen Yan, Zhou Feihu
Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
Department of Critical Care Medicine, The Seventh Medical Center, Chinese PLA General Hospital, Beijing, 100700, China.
Eur J Med Res. 2024 Dec 18;29(1):590. doi: 10.1186/s40001-024-02157-z.
Acute kidney injury (AKI) is a severe complication in critical patients receiving invasive mechanical ventilation (MV). However, AKI which occurs in the first 48 h after MV (early AKI) and thus likely associated with the MV settings is probably different from AKI occurring following 48 h (late AKI). This study is aimed at exploring the incidence of early and late AKI in elderly patients receiving MV and identifying their different risk factors and outcomes.
This retrospective, observational, multicenter cohort study consecutively included 3271 elderly patients (≥ 75 years) receiving invasive MV at four medical centers of Chinese PLA General Hospital from 2008 to 2020. The diagnosis of AKI was made following the 2012 KDIGO criteria and categorized into early (≤ 48 h) or late (> 48 h-7 days) according to the time from MV.
There were totally 1292 cases enrolled for the final analysis. Among them, 376 patients (29.1%) developed early AKI versus 132 (10.2%) developed late AKI. The 28-day mortality rates of the non-AKI, early AKI, and late AKI patients were 14.4, 46.8, and 61.4%, respectively. After 90 days, mortality rates of three groups were 33.2, 60.6, and 72.7%, respectively. Risk factors for early AKI included PaO/FIO serum creatinine, hemoglobin, and positive end-expiratory pressure at the beginning of MV, while those for late AKI were PaO/FIO serum creatinine, and hemoglobin. In the multivariable adjusted analysis, both early AKI (HR = 4.035; 95% CI = 3.166-5.142; P < 0.001) and late AKI (HR = 6.272; 95% CI = 4.654-8.453; P < 0.001) were related to the increased 28-day mortality relative to non-AKI. AKI was significantly related to 90-day mortality: early AKI (HR = 2.569; 95% CI = 2.142-3.082; P < 0.001) and late AKI (HR = 3.692; 95% CI = 2.890-4.716; P < 0.001).
AKI mostly develops in the initial 48 h following MV, which is related to the health and MV settings; while AKI occurring following 48 h is not associated with MV settings. Therefore, a strategy for kidney protection in patients with MV should take these differences into consideration.
急性肾损伤（AKI）是接受有创机械通气（MV）的危重症患者的一种严重并发症。然而，MV开始后48小时内发生的AKI（早期AKI）可能与MV设置相关，这可能与48小时后发生的AKI（晚期AKI）有所不同。本研究旨在探讨接受MV的老年患者早期和晚期AKI的发生率，并确定其不同的危险因素和预后。
这项回顾性、观察性、多中心队列研究连续纳入了2008年至2020年在中国人民解放军总医院四个医疗中心接受有创MV的3271例老年患者（≥75岁）。根据2012年KDIGO标准诊断AKI，并根据MV开始后的时间分为早期（≤48小时）或晚期（>48小时至7天）。
共有1292例患者纳入最终分析。其中，376例患者（29.1%）发生早期AKI，132例患者（10.2%）发生晚期AKI。非AKI、早期AKI和晚期AKI患者的28天死亡率分别为14.4%、46.8%和61.4%。90天后，三组的死亡率分别为33.2%、60.6%和72.7%。早期AKI的危险因素包括MV开始时的PaO₂/FIO₂、血清肌酐、血红蛋白和呼气末正压，而晚期AKI的危险因素为PaO₂/FIO₂、血清肌酐和血红蛋白。在多变量调整分析中，早期AKI（HR = 4.035；95%CI = 3.166 - 5.142；P < 0.001）和晚期AKI（HR = 6.272；95%CI = 4.654 - 8.453；P < 0.001）均与相对于非AKI患者28天死亡率增加相关。AKI与90天死亡率显著相关：早期AKI（HR = 2.569；95%CI = 2.142 - 3.082；P < 0.001）和晚期AKI（HR = 3.692；95%CI = 2.890 - 4.716；P < 0.001）。
AKI大多在MV开始后的最初48小时内发生，这与患者健康状况和MV设置有关；而48小时后发生的AKI与MV设置无关。因此，MV患者的肾脏保护策略应考虑到这些差异。
