Effect of acute kidney injury on mortality and hospital stay in patient with severe acute pancreatitis
Effect of acute kidney injury on mortality and hospital stay in patient with severe acute pancreatitis
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DOI：
10.1111/nep.12439
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发表时间：
2015-07-01
期刊：
影响因子：
2.5
通讯作者：
Fu, Ping
中科院分区：
文献类型：
--
作者：
Zhou, Jiaojiao;Li, Yi;Fu, Ping
目的重症急性胰腺炎（SAP）被认为是导致危重患者急性肾损伤（AKI）的主要危险因素，但对 SAP 诱发的 AKI 知之甚少。我们研究了急性肾损伤网络（AKIN）标准定义的 AKI 发生率以及与 SAP 诱发的 AKI 患者结局相关的危险因素。方法我们对 2009 年 8 月至 2013 年 6 月期间危重 SAP 诱发的 AKI 患者进行了多中心回顾性研究。入组患者的数据从电子记录中检索。进行单因素和多元回归分析。 结果 入住重症监护病房（ICU）的 414 例 SAP 患者中，287 例（69.3%）在 ICU 住院期间发生 AKI，其中 AKI I、II 和 III 期分别占 16.7%、18.4% 和 34.3%。 SAP 诱发的 AKI 患者在 ICU 的死亡率明显高于无 AKI 的患者。 SAP 诱发的 AKI 患者 ICU 死亡率相关的危险因素包括 ACS（比值比 (OR) 10.58）、RRT (OR 3.31)、脓毒症 (OR 2.46)、CTSI (OR 3.01)、APACHE II 评分 (OR 1.82)、AKI III (OR 1.38)、ICU 住院时间 (OR 1.04) 和多器官失败。结论该论文代表 首次尝试根据 AKIN 标准调查危重患者 SAP 后 AKI 的病因学和流行病学。研究发现几个独立的危险因素与 ICU 中 AKI 患者的死亡率相关。这些发现可能会确定关键的治疗措施，以预防弱势群体中的 AKI，并更有效地管理 SAP 引起的 AKI，从而提高重症监护的质量。
AimSevere acute pancreatitis (SAP) is believed to be a major risk factor leading to acute kidney injury (AKI) among critically ill patients, but little is known about SAP-induced AKI. We study the incidence of AKI defined by the Acute Kidney Injury Network (AKIN) criteria and the risk factors associated with outcomes among SAP-induced AKI patients.MethodWe conducted a multicenter retrospective study of critically ill SAP-induced AKI patients during the period August 2009 to June 2013. Data on enrolled patients were retrieved from electronic records. Univariate and multiple regression analyses were performed.ResultsAmong a total of 414 SAP patients admitted to intensive care units(ICU), 287 (69.3%) developed AKI during their ICU stay, with 16.7%, 18.4%, and 34.3% classified as AKI stage I,II, and III, respectively. SAP-induced AKI patients experienced a significantly higher ICU mortality than those without AKI. The risk factors associated with ICU mortality among SAP-induced AKI patients included ACS (odds ratio (OR) 10.58), RRT (OR 3.31), sepsis (OR 2.46), CTSI (OR 3.01), APACHE II score (OR 1.82), AKI III (OR 1.38), ICU-length-of-stay (OR 1.04), and multi-organ failure.ConclusionsThe paper represents the first attempt to investigate the etiology and epidemiology of AKI following SAP under the AKIN criteria among critically ill patients. Several independent risk factors were found to be associated with ICU mortality for AKI patients. The findings may pinpoint crucial therapeutic measures for preventing AKI among a vulnerable population and for more effective management of SAP-induced AKI to improve the quality of intensive care.