The Incidence of Acute Kidney In u and Associated Hospital Mortality A Retrospective Cohort Study of Over 100 000 Patients at Berlin's Charite Hospital
The Incidence of Acute Kidney In u and Associated Hospital Mortality A Retrospective Cohort Study of Over 100 000 Patients at Berlin's Charite Hospital
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DOI：
10.3238/arztebl.2019.0397
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发表时间：
2019-05-31
影响因子：
7.7
通讯作者：
Schmidt-Ott, Kai M.
中科院分区：
文献类型：
--
作者：
Khadzhynov, Dmytro;Schmidt, Danilo;Schmidt-Ott, Kai M.
工作背景：来自多个国家的研究表明，住院患者的急性肾损伤（阿基）与死亡率和发病率相关。目前尚无关于德国住院患者中阿基事件发生率和死亡率的可靠数据。阿基的行政编码对于阿基发作识别的效用也不清楚。方法：在探索性方法中，我们回顾性分析了3.5年内所有的阿基事件，（2014-2017年）根据103161例患者的常规血清肌酐测量结果，这些患者的肌酐至少测量了两次，两天我们使用“肾脏疾病：改善全球结局”（KDIGO）标准进行阿基。并联结果：在185760例住院患者中，25417例（13.7%）发生了1期阿基。2期8503例（4.6%），3期5881例（3.1%）。阿基病例与住院时间相关。肾脏发病率和总死亡率，并且这种关联是阶段依赖性的。1期阿基患者的住院死亡率为5.1%。2期阿基患者为13.7%。3期阿基患者为24.8%。在通过肌酐标准确定的阿基病例中，仅28.8%（11481例）存在急性肾损伤（N17）的行政编码。与总体阿基病例一样，那些通过肌酐标准识别但未编码为阿基的病例死亡率显着更高，并且这种相关性与分期有关。结论：阿基发作在住院患者中很常见，并且与相当大的发病率和死亡率相关，但它们没有得到充分记录，并且可能经常逃避治疗医生的注意。
Background: Studies from multiple countries have shown that acute kidney injury (AKI) in hospitalized patients is associated with mortality and morbidity. There are no reliable data at present on the incidence and mortality of AKI episodes among hospitalized patients in Germany. The utility of administrative codings of AKI for the identification of AKI episodes is also unclear.Methods: In an exploratory approach, we retrospectively analyzed all episodes of AKI over a period of 3.5 years (2014-2017) on the basis of routinely obtained serum creatinine measurements in 103 161 patients whose creatinine had been measured at least twice and who had been in the hospital for at least two days. We used the "Kidney Disease: Improving Global Outcomes" (KDIGO) criteria for AKI. In parallel. we assessed the administrative coding of discharge diagnoses of the same patients with codes from the International Classification of Diseases (ICD-10-GM).Results: Among 185 760 hospitalizations, stage 1 AKI occurred in 25 417 cases (13.7%). stage 2 in 8503 cases (4.6%), and stage 3 in 5881 cases (3.1%). AKI cases were associated with length of hospital stay. renal morbidity. and overall mortality, and this association was stage-dependent. The in-hospital mortality was 5.1%for patients with stage 1 AKI. 13.7% for patients with stage 2 AKI. and 24.8% for patients with stage 3 AKI. An administrative coding for acute kidney injury (N17) was present in only 28.8% (11 481) of the AKI cases that were identified by creatinine criteria. Like the AKI cases overall, those that were identified by creatinine criteria but were not coded as AKI had significantly higher mortality, and this association was stage-dependent.Conclusion: AKI episodes are common among hospitalized patients and are associated with considerable morbidity and mortality, yet they are inadequately documented and probably often escape the attention of the treating physicians.