Kadota Nozomi, Fujimaru Takuya, Takahashi Osamu, Konishi Kasumi, Ito Yugo, Nagahama Masahiko, Taki Fumika, Suzuki Michiko, Nakayama Masaaki
Department of Nephrology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
Department of General Internal Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
Clin Exp Nephrol. 2025 May 4. doi: 10.1007/s10157-025-02681-0.
Unplanned intensive care unit (ICU) transfers owing to clinical deterioration contribute to in-hospital mortality. The risk factors for unplanned ICU transfers among the general population have been investigated, whereas those among patients undergoing hemodialysis remain unclear. Therefore, this study aimed to examine the risk factors for clinical deterioration in hospitalized patients undergoing hemodialysis.
We conducted a single-center, retrospective, observational cohort study, focusing on hospitalized adult patients receiving maintenance hemodialysis between January 2003 and December 2020. Age, sex, planned or emergency hospitalization type, hemodialysis duration, vital signs, quick sequential organ failure assessment score, serum albumin levels, and comorbid conditions (diabetes mellitus, coronary artery disease [CAD], peripheral artery disease, cerebrovascular disease, intradialytic hypotension, and cancer) were considered as predictors. For all predictors, data at admission were used. Outcomes measured included clinical deterioration, unplanned ICU transfers within 72 h to 30 days after admission, and sudden death within 30 days.
Among the 389 enrolled patients (median age: 73.1 years, 64.3% male), 40 patients experienced clinical deterioration: 37 (9.5%) underwent unplanned ICU transfers, and 3 (0.8%) experienced sudden deaths in general wards. In-hospital mortality was significantly higher in the deterioration group than in the non-deterioration group (62.5% vs 5.4%, p < 0.001, respectively). Cox regression analysis identified CAD as an independent risk factor for clinical deterioration (hazard ratio: 2.11; 95% confidence interval: 1.05-4.24).
CAD is a risk factor for clinical deterioration in hospitalized patients undergoing hemodialysis.
因临床病情恶化导致的非计划性重症监护病房（ICU）转运会增加住院死亡率。一般人群中非计划性ICU转运的风险因素已得到研究，但接受血液透析患者的相关风险因素仍不明确。因此，本研究旨在探讨住院血液透析患者临床病情恶化的风险因素。
我们进行了一项单中心、回顾性、观察性队列研究，重点关注2003年1月至2020年12月期间接受维持性血液透析的住院成年患者。年龄、性别、计划性或急诊住院类型、血液透析时长、生命体征、快速序贯器官衰竭评估评分、血清白蛋白水平以及合并症（糖尿病、冠状动脉疾病[CAD]、外周动脉疾病、脑血管疾病、透析中低血压和癌症）被视为预测因素。所有预测因素均采用入院时的数据。测量的结局包括临床病情恶化、入院后72小时至30天内的非计划性ICU转运以及30天内的猝死。
在389名入组患者中（中位年龄：73.1岁，64.3%为男性），40例患者出现临床病情恶化：37例（9.5%）接受了非计划性ICU转运，3例（0.8%）在普通病房发生猝死。恶化组的住院死亡率显著高于未恶化组（分别为62.5%和5.4%，p<0.001）。Cox回归分析确定CAD是临床病情恶化的独立风险因素（风险比：2.11；95%置信区间：1.05 - 4.24）。
CAD是住院血液透析患者临床病情恶化的风险因素。
