非心脏术后急性肾损伤危重患者血清肌酐升高与近期预后的相关性  

Acute kidney injury diagnosed by elevated serum creatinine increases mortality in ICU patients following non-cardiac surgery

作　　者：谢旻[1] 李楠[1] 乔虹[1] 郭镜飞 李双玲[1] Xie Min;Li Nan;Qiao Hong;Guo Jingfei;Li Shuangling(Department of Critical Care Medicine,Peking University First Hospital,Beijing 100034,China;Department of Anesthesiology,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]北京大学第一医院重症医学科,北京100034 [2]中国医学科学院阜外心血管病医院麻醉科,北京100037

出　　处：《中华医学杂志》2020年第42期3285-3290,共6页National Medical Journal of China

基　　金：北京大学第一医院交叉临床研究专项基金(2018CR32)。

摘　　要：目的分析非心脏手术后危重患者中,当使用改善全球肾脏病预后(KDIGO)标准诊断急性肾损伤(AKI)时,以血清肌酐(Scr)升高诊断AKI的患者,与仅以少尿标准诊断AKI的患者相比,是否预后更差。方法前期回顾性队列研究数据的二次分析。纳入2017年7月至2018年6月在北京大学第一医院行非心脏手术后进入重症监护病房(ICU)有AKI高危因素的成年患者729例,依据KDIGO诊断和分级标准诊断术后AKI并分级。二次分析时选取所有符合AKI诊断的患者,符合Scr升高标准的分入AKI-Scr组,仅符合尿量(UO)减少标准的分入AKI-UO组。使用多因素logistic回归模型,判断术后AKI患者中Scr升高与住院死亡率之间的关系。结果188例AKI患者,年龄(71±14)岁,男114例(60.6%);AKI-Scr组72例(38.3%),AKI-UO组116例(61.7%)。AKI-Scr组住院死亡率为16.7%,明显高于AKI-UO组患者的0.9%(P<0.001)。AKI-Scr组术后住院时间、ICU停留时间和术后机械通气时间均长于AKI-UO组,医疗总费用也高于AKI-UO组(均P<0.05)。多因素logistic回归分析结果显示,术后AKI患者中Scr升高(OR=20.286,95%CI:2.544~161.797,P=0.004)和术前低蛋白血症(OR=4.897,95%CI:1.240~19.329,P=0.023)是住院死亡的独立危险因素。结论非心脏术后以Scr升高诊断AKI的患者,与仅以少尿诊断AKI的患者相比,住院死亡率更高,伴随多项近期预后指标恶化和医疗总费用增高。临床医师应更加关注以Scr升高诊断的AKI患者,适当倾斜医疗资源,有望改善患者预后。Objective To analyze whether acute kidney injury(AKI)patients diagnosed by elevated serum creatinine had a higher risk of in-hospital mortality following non-cardiac surgery compared with those diagnosed by oliguria alone according to Kidney Disease:Improving Global Outcomes(KDIGO)criteria.Methods This was a secondary analysis of a previous retrospective cohort study.A total of 729 consecutive adult patients with high risk of AKI admitted to the intensive care unit(ICU)of Peking University First Hospital after non-cardiac surgery were enrolled in the previous study from July 2017 to June 2018.Postoperative AKI patients were diagnosed and categorized according to KDIGO criteria.In this secondary analysis,all patients with AKI were selected.Patients diagnosed by elevated serum creatinine were enrolled into the AKI-Scr group,while those with oliguria alone were included in the AKI-UO group.A multivariable logistic regression model was established to assess the relationship between elevated serum creatinine and in-hospital mortality in AKI patients.Results Of 188 AKI patients[(71±14)years,114 males(60.6%)],72(38.3%)and 116(61.7%)patients were enrolled in AKI-Scr and AKI-UO group,respectively.The rate of in-hospital mortality was 16.7%in AKI-Scr group,which was significantly higher than that in AKI-UO group(0.9%,P<0.001).Furthermore,patients in AKI-Scr group had longer postoperative hospital and ICU stay,more duration of mechanical ventilation and higher total medical costs(all P<0.05).Multivariate logistic regression analysis revealed that AKI-Scr(OR=20.286,95%CI:2.544-161.797,P=0.004)and preoperative hypoproteinemia(OR=4.897,95%CI:1.240-19.329,P=0.023)were independent risk factors for in-hospital mortality in postoperative AKI patients.Conclusions AKI patients diagnosed by increased serum creatinine had a higher risk of in-hospital mortality following non-cardiac surgery,accompanied by several worsen short-term outcomes and higher total medical costs,compared with those diagnosed by oliguria alone according to the

关 键 词：急性肾功能不全 手术后并发症 肌酐 预后 

分 类 号：R692[医药卫生—泌尿科学]