Singh Sarjit, Andonovic Mark, Traynor Jamie P, Shaw Martin F, Sim Malcolm A B, Mark Patrick B, Puxty Kathryn A
Academic Unit of Anaesthesia, Critical Care and Perioperative Medicine, University of Glasgow, Glasgow, UK.
Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.
Clin Kidney J. 2025 May 30;18(6):sfaf170. doi: 10.1093/ckj/sfaf170. eCollection 2025 Jun.
Patients admitted to intensive care units (ICUs) frequently develop acute kidney injury (AKI). There is limited research comparing outcomes between oliguric and non-oliguric AKI in this population. This study aimed to investigate the short- and long-term outcomes in oliguric and non-oliguric AKI in intensive care patients; the specific outcomes assessed were mortality and major adverse kidney events. We hypothesised that short- and long-term outcomes would be poorer in oliguric compared with non-oliguric AKI in intensive care patients.
This retrospective observational cohort study utilised prospectively collected data routinely gathered during patients' admission. All adult patients >16 years of age admitted to two large Scottish general adult ICUs were included. Patients with long-term kidney replacement therapy, prior transplantation and ICU readmission were excluded. Oliguria was defined as urine output <0.3 ml/kg/h for 24 h. Outcomes were assessed using Cox proportional hazards analyses; should its assumptions be violated, odds ratios at prespecified time points were undertaken.
Of the 2147 patients identified with AKI, 1666 had sufficient urine output data for analysis. A total of 528 (31.7%) subjects had oliguric AKI lasting at least 24 h. The 1-year mortality was higher in oliguric patients [adjusted hazard ratio 1.45 (95% confidence interval 1.02-2.12), -value 1.93]. Our data violated the proportional hazards assumption for major adverse kidney events; the 1-year odds ratio for major adverse renal events was non-significant at 1.25 (95% confidence interval 0.92-1.69).
Our study demonstrated that one-third of patients with AKI in intensive care developed oliguria using a standardised definition of oliguria. Oliguric AKI was found to be significantly associated with higher rates of mortality from in-critical care through 1-year post-discharge.
入住重症监护病房（ICU）的患者经常发生急性肾损伤（AKI）。在这一人群中，比较少尿型和非少尿型AKI结局的研究有限。本研究旨在调查重症监护患者少尿型和非少尿型AKI的短期和长期结局；评估的具体结局为死亡率和主要不良肾脏事件。我们假设，与重症监护患者的非少尿型AKI相比，少尿型AKI的短期和长期结局更差。
这项回顾性观察队列研究利用了患者入院期间常规收集的前瞻性数据。纳入了入住两家大型苏格兰普通成人ICU的所有年龄>16岁的成年患者。排除接受长期肾脏替代治疗、先前接受过移植和再次入住ICU的患者。少尿定义为24小时尿量<0.3 ml/kg/h。使用Cox比例风险分析评估结局；如果其假设被违反，则采用预定时间点的比值比。
在2147例确诊为AKI的患者中，1666例有足够的尿量数据进行分析。共有528例（31.7%）受试者发生少尿型AKI，持续至少24小时。少尿患者的1年死亡率更高[调整后风险比1.45（95%置信区间1.02-2.12），P值1.93]。我们的数据违反了主要不良肾脏事件的比例风险假设；主要不良肾脏事件的1年比值比为1.25，无统计学意义（95%置信区间0.92-1.69）。
我们的研究表明，按照少尿的标准化定义，重症监护中三分之一的AKI患者出现少尿。发现少尿型AKI与重症监护期间至出院后1年的较高死亡率显著相关。
