Acute Kidney Injury and Risk of Heart Failure and Atherosclerotic Events
Acute Kidney Injury and Risk of Heart Failure and Atherosclerotic Events
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DOI：
10.2215/cjn.12591117
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发表时间：
2018-06-07
影响因子：
9.8
通讯作者：
Liu, Kathleen D.
中科院分区：
文献类型：
--
作者：
Go, Alan S.;Hsu, Chi-yuan;Liu, Kathleen D.
背景和目的医院中的阿基很常见，并且与死亡率过高有关。我们研究了阿基是否也与出院后第一年不同心血管事件的高风险独立相关。设计、设置、参与者和测量我们对2006年至2013年期间的队列进行了回顾性分析，随访至2014年，在北方加州的凯撒医疗机构。我们确定了21家医院收治的所有成年人，他们有一个或多个住院血清肌酐检测结果，并存活到出院。阿基的发生基于肾脏疾病：改善全球结局诊断标准。从综合住院和门诊、实验室和药房电子病历中确定潜在混杂因素。在出院后的365天内，我们从电子病历中确定了心力衰竭、急性冠状动脉综合征、外周动脉疾病和缺血性卒中事件的发生率。在出院后365天，阿基与因心力衰竭和动脉粥样硬化事件住院的复合结局发生率较高独立相关（校正的风险比[aHR]，1.18; 95%置信区间[95% CI]，1.13 - 1.25），即使调整了人口统计学、合并症、入院前eGFR和蛋白尿、心力衰竭和住院并发败血症，重症监护室（ICU）入院、住院时间和预计住院死亡率。这是由随后心力衰竭的过度风险（aHR，1.44; 95%CI，1.33至1.56）驱动的，而与随访动脉粥样硬化事件无显著相关性（aHR，1.05; 95%CI，0.98至1.12）。结论阿基与出院后心血管事件，尤其是心力衰竭的高风险独立相关。
Background and objectives AKI in the hospital is common and is associated with excess mortality. We examined whether AKI is also independently associated with a higher risk of different cardiovascular events in the first year after discharge.Design, setting, participants, & measurements We conducted a retrospective analysis of a cohort between 2006 and 2013 with follow-up through 2014, within Kaiser Permanente Northern California. We identified all adults admitted to 21 hospitals who had one or more in-hospital serum creatinine test result and survived to discharge. Occurrence of AKI was on the basis of Kidney Disease: Improving Global Outcomes diagnostic criteria. Potential confounders were identified from comprehensive inpatient and outpatient, laboratory, and pharmacy electronic medical records. During the 365 days after discharge, we ascertained occurrence of heart failure, acute coronary syndromes, peripheral artery disease, and ischemic stroke events from electronic medical records.Results Among a matched cohort of 146,941 hospitalized adults, 31,245 experienced AKI. At 365 days postdischarge, AKI was independently associated with higher rates of the composite outcome of hospitalization for heart failure and atherosclerotic events (adjusted hazard ratio [aHR], 1.18; 95% confidence interval [95% CI], 1.13 to 1.25) even after adjustment for demographics, comorbidities, preadmission eGFR and proteinuria, heart failure and sepsis complicating the hospitalization, intensive care unit (ICU) admission, length of stay, and predicted in-hospital mortality. This was driven by an excess risk of subsequent heart failure (aHR, 1.44; 95% CI, 1.33 to 1.56), whereas there was no significant association with follow-up atherosclerotic events (aHR, 1.05; 95% CI, 0.98 to 1.12).Conclusions AKI is independently associated with a higher risk of cardiovascular events, especially heart failure, after hospital discharge.