Risk factors and 180-day mortality of acute kidney disease in critically ill patients: A multi-institutional study

被引:3
作者
Pan, Heng-Chi [1 ,2 ]
Chen, Hsing-Yu [3 ,4 ,5 ]
Chen, Hui-Ming [6 ]
Huang, Yu-Tung [6 ]
Fang, Ji-Tseng [1 ,7 ]
Chen, Yung-Chang [1 ,7 ]
机构
[1] Chang Gung Univ, Coll Med, Taoyuan, Taiwan
[2] Keelung Chang Gung Mem Hosp, Dept Internal Med, Div Nephrol, Keelung, Taiwan
[3] Chang Gung Univ, Grad Inst Clin Med Sci, Coll Med, Taoyuan, Taiwan
[4] Chang Gung Mem Hosp, Ctr Tradit Chinese Med, Div Chinese Internal Med, Taoyuan, Taiwan
[5] Chang Gung Univ, Coll Med, Sch Tradit Chinese Med, Taoyuan, Taiwan
[6] Chang Gung Mem Hosp, Ctr Big Data Analyt & Stat, Linkou Med Ctr, Taoyuan, Taiwan
[7] Linkou Chang Gung Mem Hosp, Dept Internal Med, Div Nephrol, Taoyuan, Taiwan
关键词
acute kidney injury; acute kidney disease; chronic kidney disease; risk factor; survival; INJURY; CONSENSUS;
D O I
10.3389/fmed.2023.1153670
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundCritically ill patients with acute kidney injury (AKI) have a poor prognosis. Recently, the Acute Disease Quality Initiative (ADQI) proposed to define acute kidney disease (AKD) as acute or subacute damage and/or loss of kidney function post AKI. We aimed to identify the risk factors for the occurrence of AKD and to determine the predictive value of AKD for 180-day mortality in critically ill patients. MethodsWe evaluated 11,045 AKI survivors and 5,178 AKD patients without AKI, who were admitted to the intensive care unit between 1 January 2001 and 31 May 2018, from the Chang Gung Research Database in Taiwan. The primary and secondary outcomes were the occurrence of AKD and 180-day mortality. ResultsThe incidence rate of AKD among AKI patients who did not receive dialysis or died within 90 days was 34.4% (3,797 of 11,045 patients). Multivariable logistic regression analysis indicated that AKI severity, underlying early CKD, chronic liver disease, malignancy, and use of emergency hemodialysis were independent risk factors of AKD, while male gender, higher lactate levels, use of ECMO, and admission to surgical ICU were negatively correlated with AKD. 180-day mortality was highest among AKD patients without AKI during hospitalization (4.4%, 227 of 5,178 patients), followed by AKI with AKD (2.3%, 88 of 3,797 patients) and AKI without AKD (1.6%, 115 of 7,133 patients). AKI with AKD had a borderline significantly increased risk of 180-day mortality (aOR 1.34, 95% CI 1.00-1.78; p = 0.047), while patients with AKD but no preceding AKI episodes had the highest risk (aOR 2.25, 95% CI 1.71-2.97; p < 0.001). ConclusionThe occurrence of AKD adds limited additional prognostic information for risk stratification of survivors among critically ill patients with AKI but could predict prognosis in survivors without prior AKI.
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页数:11
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