老年住院患者急性肾损伤科室分布与临床流行病学分析  

Departmental distribution and clinical epidemiology of acute kidney injury in hospitalized elders

作　　者：赵兴阳 徐钢[1] 葛树旺[1] Zhao Xing-yang;Xu Gang;Ge Shu-wang(Department of Nephrology,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院肾内科,武汉430030

出　　处：《临床肾脏病杂志》2024年第3期185-194,共10页Journal Of Clinical Nephrology

基　　金：国家自然科学基金(91742204);国家重点研发计划(2021YFC2500200)。

摘　　要：目的本研究旨在分析老年住院患者急性肾损伤(acute kidney injury,AKI)在不同临床科室的分布、发生率、临床特点以及与院内死亡相关的危险因素。方法回顾性分析2018年1月1日至2022年12月31日期间在华中科技大学同济医学院附属同济医院入院且年龄≥65岁的老年患者病历。收集的临床数据包括人口学资料、合并症、药物使用情况和实验室检查结果。AKI的定义依据改善全球肾脏病预后组织指南,基于动态基线肌酐算法判断AKI的发生。采用堆积柱状图展示AKI的不同科室分布和发生率,运用单因素及多因素Logistic回归分析老年AKI患者院内死亡的危险因素,采用Kaplan-Meier生存曲线及Log-rank检验比较不同AKI分级患者的累积生存率。结果符合纳排标准的老年患者共154696例,其中6879例(4.4%)发生AKI。不同科室中的AKI分布和发生率存在显著差异。重症医学科的发生率最高(30.1%),其次是心脏大血管外科(24.3%)和创伤外科(11.3%)。老年AKI患者的院内病死率为15.9%,且随AKI级别增加而上升。多因素Logistics回归分析发现,更高的AKI分级(OR=2.89,95%CI:2.15~3.88,P<0.001)、肺部感染(OR=2.01,95%CI:1.59~2.56,P<0.001)、恶性肿瘤(OR=1.59,95%CI:1.25~2.04,P<0.001)、低白蛋白血症(OR=1.94,95%CI:1.54~2.43,P<0.001)等是老年AKI患者院内死亡的独立危险因素。在符合标准的AKI人群中,仅有6.0%的患者出院有“AKI”诊断。结论华中科技大学同济医学院附属同济医院老年住院患者AKI发生率随年龄增加而提高,老年AKI患者大多合并基础疾病及使用肾毒性药物,且多分布在肾病内科以外的临床科室。年龄、AKI分级、肺部感染、糖尿病、恶性肿瘤、低蛋白血症等是老年AKI患者院内死亡的危险因素。住院期间多数AKI被漏诊,临床医生应提高对老年AKI患者的重视。Objective To explore the distribution,incidence,clinical characteristics,and in-hos-pital mortality risk factors associated with acute kidney injury(AKI)in hospitalized elders across various clinical departments.Method A retrospective analysis was conducted for medical records of elders aged≥65 years admitted between January 1,2018,and December 31,2022.Collected clinical data included de-mographic profiles,comorbidities,medication usage and laboratory test results.AKI was defined based up-on the dynamic baseline creatinine algorithm according to the guidelines of the Kidney Disease:Improving Global Outcomes.Stacked bar charts were employed for displaying the distribution and incidence of AKI across different departments.Univariate and multivariate Logistic regression analyses were performed for examining various risk factors for in-hospital mortality.Kaplan-Meier survival curve and Log-rank test were employed for comparing cumulative survival rates among elders of varying AKI stages.Results A total of 154,696 elder episodes fulfilled the inclusion criteria and 6,879(4.4%)developed AKI.Significant differences existed in the distribution and incidence of AKI across departments.The highest incidence was in Intensive Care Unit at 30.1%,followed by Cardiovascular Surgery at 24.3%and Trauma Surgery at 11.3%.The in-hospital mortality rate of AKI elders was 15.9%and it spiked with AKI severity.Multivari-ate Logistic regression analysis revealed that higher AKI stages(OR=2.89,95%CI:2.15-3.88,P<0.001),pulmonary infection(OR=2.01,95%CI:1.59-2.56,P<0.001),malignancy(OR=1.59,95%CI:1.25-2.04,P<0.001)and hypoalbuminemia(OR=1.94,95%CI:1.54-2.43,P<0.001)were independent risk factors for in-hospital mortality.Only 6.0%of AKI elders had an“AKI”diagnosis at discharge.Conclusion The incidence of AKI in elders rises with age.AKI elders often have underlying diseases and receive nephrotoxic medications,predominantly at clinical departments other than nephrology.Age,AKI stage,pulmonary infection,DM,malignancy and hypoalbuminemia a

关 键 词：急性肾损伤 老年患者 流行病学 

分 类 号：R692[医药卫生—泌尿科学]