Hospital-Acquired Versus Community-Acquired Acute Kidney Injury in Patients With Cirrhosis: A Prospective Study
Hospital-Acquired Versus Community-Acquired Acute Kidney Injury in Patients With Cirrhosis: A Prospective Study
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DOI：
10.14309/ajg.0000000000000670
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发表时间：
2020-09-01
影响因子：
9.8
通讯作者：
Orman, Eric S.
中科院分区：
文献类型：
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作者：
Patidar, Kavish R.;Shamseddeen, Hani;Orman, Eric S.
前言：在肝硬变患者中，入院时的急性肾损伤(AKI)(社区获得性)和住院期间发生的AKI(医院获得性)之间的差异尚未被探讨。我们的目的是在一项大型的前瞻性研究中比较医院获得性急性KI(H-AKI)和社区获得性AKI(C-AKI)患者。方法：入选519名住院的肝硬变患者，出院后跟踪观察90天死亡率。主要结果是90天内死亡；次要结果是新发慢性肾脏疾病(CKD)的发展/90天后CKD的进展。结果：H-AKI发生率为10%，C-AKI发生率为25%。在调整了显著混杂因素的多变量COX模型中，仅有C-AKI患者在调整终末期肝病模型-Na：(风险比1.64，95%可信区间1.04-2.57，P=0.033)和调整急性慢性肝衰竭的风险：(风险比2.44，95%可信区间1.63-3.65，P<；0.001)。在单因素分析中，社区获得性急性肾功能不全与慢性肾脏病的新发/进展相关(优势比2.13，95%可信区间1.09~4.14，P=0.027)，但在多因素分析中，社区获得性急性肾功能不全与慢性肾脏病的新发/进展无关。然而，按分期进行二分法后，C-AKI分期3与新发CKD/进展独立相关(优势比4.79，95%可信区间1.11~2 0.57，P=0.035)。C-AKI患者可能受益于出院后的频繁监测以改善预后。
INTRODUCTION: In patients with cirrhosis, differences between acute kidney injury (AKI) at the time of hospital admission (community-acquired) and AKI occurring during hospitalization (hospital-acquired) have not been explored. We aimed to compare patients with hospital-acquired AKI (H-AKI) and community-acquired AKI (C-AKI) in a large, prospective study.METHODS: Hospitalized patients with cirrhosis were enrolled (N = 519) and were followed for 90 days after discharge for mortality. The primary outcome was mortality within 90 days; secondary outcomes were the development ofde novochronic kidney disease (CKD)/progression of CKD after 90 days. Cox proportional hazards and logistic regressions were used to determine the independent association of either AKI for primary and secondary outcomes, respectively.RESULTS: H-AKI occurred in 10%, and C-AKI occurred in 25%. In multivariable Cox models adjusting for significant confounders, only patients with C-AKI had a higher risk for mortality adjusting for model for end-stage liver disease-Na: (hazard ratio 1.64, 95% confidence interval [CI] 1.04-2.57,P= 0.033) and adjusting for acute on chronic liver failure: (hazard ratio 2.44, 95% CI 1.63-3.65,P< 0.001). In univariable analysis, community-acquired-AKI, but not hospital-acquired-AKI, was associated withde novoCKD/progression of CKD (odds ratio 2.13, 95% CI 1.09-4.14,P= 0.027), but in multivariable analysis, C-AKI was not independently associated withde novoCKD/progression of CKD. However, when AKI was dichotomized by stage, C-AKI stage 3 was independently associated withde novoCKD/progression of CKD (odds ratio 4.79, 95% CI 1.11-20.57,P= 0.035).DISCUSSION: Compared with H-AKI, C-AKI is associated with increased mortality andde novoCKD/progression of CKD in patients with cirrhosis. Patients with C-AKI may benefit from frequent monitoring after discharge to improve outcomes.