Hospital-acquired acute kidney injury and hospital readmission: a cohort study.
Hospital-acquired acute kidney injury and hospital readmission: a cohort study.
复制标题
DOI：
10.1053/j.ajkd.2014.08.024
复制
发表时间：
2015-03
期刊：
影响因子：
--
通讯作者：
Jaber BL
中科院分区：
文献类型：
--
作者：
Koulouridis I;Price LL;Madias NE;Jaber BL
医院获得性急性肾损伤（AKI）与死亡率和资源消耗增加有关。我们对AKI与短期再入院的关系知之甚少。回顾性队列研究。我们调查了医院获得性AKI的成年幸存者早期再入院的几率是否增加。根据KDIGO（肾脏疾病：改善总体预后）分类和分期系统，使用指数住院期间血清肌酐峰值至最低点的差异来定义AKI。通过调整年龄、性别、种族、Charlson-Deyo合并症指数评分、急性住院相关因素、常见住院原因和基线肾小球滤过率，多变量logistic回归分析检验了AKI与30天、60天和90天再入院的关系。22,001例患者中有3,345例（15%）在指数住院期间经历AKI。与非AKI组相比，AKI组的30天再入院率明显更高（11% vs 15%; P < 0.001），持续到60天和90天。AKI组也更有可能在30天内因心血管相关疾病再次入院，主要是心力衰竭（P < 0.001）和急性心肌梗死（P = 0.01）。AKI与较高的30天再入院几率独立相关（OR, 1.21; 95% CI, 1.08-1.36），持续到60天（OR, 1.15; 95% CI, 1.03-1.27）和90天（调整OR， 1.13; 95% CI, 1.02-1.25）。在5,912名患者的倾向评分匹配队列中，结果有所减弱。轻度AKI的单中心研究；行政法规的使用导致的确定偏差和结果错误分类。我们的研究结果表明，医院获得性AKI的幸存者早期再入院的几率更高。为防止此类患者再入院并降低医疗费用，护理服务的转变可能是有必要的。
Hospital-acquired acute kidney injury (AKI) is associated with increased mortality and resource consumption. Little is known about the association of AKI with short-term hospital readmissions. Retrospective cohort study. We investigated whether adult survivors of hospital-acquired AKI were at increased odds for early hospital readmission. The peak-to-nadir serum creatinine difference during the index hospitalization was used to define AKI according to the KDIGO (Kidney Disease: Improving Global Outcomes) classification and staging system. Multivariable logistic regression analyses examined the association of AKI with 30-, 60-, and 90-day hospital readmission, adjusting for age, sex, race, Charlson-Deyo comorbidity index score, acute hospital-related factors, common causes of hospitalization, and baseline estimated glomerular filtration rate. 3,345 (15%) of 22,001 included patients experienced AKI during the index hospitalization. Compared to the non-AKI group, the AKI group had a significantly higher 30-day hospital readmission rate (11% vs 15%; P < 0.001), which persisted at 60 and 90 days. The AKI group also was more likely to be readmitted to the hospital within 30 days for cardiovascular-related conditions, mainly heart failure (P < 0.001) and acute myocardial infarction (P = 0.01). AKI associated independently with higher odds of 30-day hospital readmission (OR, 1.21; 95% CI, 1.08–1.36), which persisted at 60 (OR, 1.15; 95% CI, 1.03–1.27) and 90 days (adjusted OR, 1.13; 95% CI, 1.02–1.25). Results were attenuated in a propensity score–matched cohort of 5,912 patients. Single-center study of mild forms of AKI; ascertainment bias and outcome misclassification due to the use of administrative codes. Our results suggest that survivors of hospital-acquired AKI experience higher odds of early hospital readmission. Transitions of care services may be warranted for such patients to prevent readmissions and reduce health care costs.
登录
查看更多内容
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
DOI：
10.2215/cjn.00710113
发表时间：
2013-09-06
影响因子：
9.8
作者：
Susantitaphong, Paweena;Cruz, Dinna N.;Jaber, Bertrand L.
通讯作者：
Jaber, Bertrand L.
围手术期急性肾脏损伤是心脏手术后三十天再入院的严重程度指数的影响。
影响因子：
4.6
作者：
Brown, Jeremiah R.;Parikh, Chirag R.;Ross, Cathy S.;Kramer, Robert S.;Magnus, Patrick C.;Chaisson, Kristine;Boss, Richard A., Jr.;Helm, Robert E.;Horton, Susan R.;Hofmaster, Patricia;Desaulniers, Helen;Blajda, Pamela;Westbrook, Benjamin M.;Duquette, Dennis;LeBlond, Kelly;Quinn, Reed D.;Jones, Cheryl;DiScipio, Anthony W.;Malenka, David J.
通讯作者：
Malenka, David J.
影响因子：
158.5
作者：
Jencks, Stephen F.;Williams, Mark V.;Coleman, Eric A.
通讯作者：
Coleman, Eric A.
影响因子：
39.2
作者：
Levey AS;Stevens LA;Schmid CH;Zhang YL;Castro AF 3rd;Feldman HI;Kusek JW;Eggers P;Van Lente F;Greene T;Coresh J;CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
通讯作者：
CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)