Multiple-center evaluation of mortality associated with acute kidney injury in critically ill patients: a competing risks analysis.
Multiple-center evaluation of mortality associated with acute kidney injury in critically ill patients: a competing risks analysis.
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DOI：
10.1186/cc10241
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Timsit JF
中科院分区：
文献类型：
--
作者：
Clec'h C;Gonzalez F;Lautrette A;Nguile-Makao M;Garrouste-Orgeas M;Jamali S;Golgran-Toledano D;Descorps-Declere A;Chemouni F;Hamidfar-Roy R;Azoulay E;Timsit JF
在这项研究中，我们旨在使用原始的竞争风险方法评估急性肾损伤（AKI）与危重患者死亡率之间的关联。这项观察性队列研究纳入了 1997 年至 2009 年间入住 13 个法国医疗或外科重症监护病房的未经选择的患者。 AKI 根据 RIFLE 标准定义。记录以下数据：基线特征、每日血清肌酐水平、每日序贯器官衰竭评估（SOFA）评分、出院时的生命状态和住院时间。根据患者在 ICU 住院期间达到的最大 RIFLE 等级对患者进行分类。根据 Fine 和 Gray 模型评估 AKI 与医院死亡率（“存活出院”被视为竞争事件）之间的关联。在 8,639 名研究患者中，32.9% 患有 AKI，其中 19.1% 接受肾脏替代治疗。与无 AKI 的患者相比，AKI 患者的粗死亡率更高，住院时间更长。在 Fine and Gray 模型中，医院死亡率的独立危险因素是 RIFLE 类别风险（子危险比 (SHR) 1.58 和 95% 置信区间 (95% CI) 1.32 至 1.88；P < 0.0001）、损伤（SHR 3.99 和 95% CI 3.43 至 4.65；P < 0.0001）和失败 (SHR) 4.12 和 95% CI 3.55 至 4.79；P < 0.0001)；非肾 SOFA 评分（SHR 1.19 每点，95% CI 1.18 至 1.21；P < 0.0001）； McCabe 3 级（SHR 2.71 和 95% CI 2.34 至 3.15；P < 0.0001）；和呼吸衰竭（SHR 3.08 和 95% CI 1.36 至 7.01；P < 0.01）。通过使用竞争风险方法，我们在这项研究中证实，影响危重患者的 AKI 与院内死亡率增加相关。
In this study, we aimed to assess the association between acute kidney injury (AKI) and mortality in critically ill patients using an original competing risks approach. Unselected patients admitted between 1997 and 2009 to 13 French medical or surgical intensive care units were included in this observational cohort study. AKI was defined according to the RIFLE criteria. The following data were recorded: baseline characteristics, daily serum creatinine level, daily Sequential Organ Failure Assessment (SOFA) score, vital status at hospital discharge and length of hospital stay. Patients were classified according to the maximum RIFLE class reached during their ICU stay. The association of AKI with hospital mortality with "discharge alive" considered as a competing event was assessed according to the Fine and Gray model. Of the 8,639 study patients, 32.9% had AKI, of whom 19.1% received renal replacement therapy. Patients with AKI had higher crude mortality rates and longer lengths of hospital stay than patients without AKI. In the Fine and Gray model, independent risk factors for hospital mortality were the RIFLE classes Risk (sub-hazard ratio (SHR) 1.58 and 95% confidence interval (95% CI) 1.32 to 1.88; P < 0.0001), Injury (SHR 3.99 and 95% CI 3.43 to 4.65; P < 0.0001) and Failure (SHR 4.12 and 95% CI 3.55 to 4.79; P < 0.0001); nonrenal SOFA score (SHR 1.19 per point and 95% CI 1.18 to 1.21; P < 0.0001); McCabe class 3 (SHR 2.71 and 95% CI 2.34 to 3.15; P < 0.0001); and respiratory failure (SHR 3.08 and 95% CI 1.36 to 7.01; P < 0.01). By using a competing risks approach, we confirm in this study that AKI affecting critically ill patients is associated with increased in-hospital mortality.
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影响因子：
6.1
作者：
Bagshaw, Sean M.;George, Carol;Bellomo, Rinaldo
通讯作者：
Bellomo, Rinaldo
急性肾脏损伤的步枪标准与重症患者的医院死亡率有关：一项队列分析。
影响因子：
15.1
作者：
Hoste, Eric A. J.;Clermont, Gilles;Kersten, Alexander;Venkataraman, Ramesh;Angus, Derek C.;De Bacquer, Dirk;Kellum, John A.
通讯作者：
Kellum, John A.
影响因子：
13.2
作者：
Abosaif, NY;Tolba, YA;El Nahas, AM
通讯作者：
El Nahas, AM
影响因子：
8.8
作者：
Azoulay, E;Alberti, C;Schlemmer, B
通讯作者：
Schlemmer, B
影响因子：
--
作者：
MCCABE, WR;JACKSON, GG
通讯作者：
JACKSON, GG