Septic acute kidney injury patients in emergency department: The risk factors and its correlation to serum lactate
Septic acute kidney injury patients in emergency department: The risk factors and its correlation to serum lactate
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DOI：
10.1016/j.ajem.2018.05.012
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发表时间：
2019-02-01
影响因子：
3.6
通讯作者：
Hsu, Chih-Wei
中科院分区：
文献类型：
--
作者：
Hsu, Yin-Chou;Hsu, Chih-Wei
背景资料：急性肾损伤（阿基）是脓毒症患者的常见并发症，在发病率和死亡率方面造成了沉重的疾病负担。血清乳酸是一种广泛使用的预测脓毒症严重程度的指标。很少有研究调查急诊科（ED）的脓毒性阿基及其与初始血清乳酸水平的相关性。本研究旨在确定脓毒性阿基的危险因素，并阐明初始乳酸盐水平和脓毒性阿基之间的联系，在艾德patients.Methods：回顾性队列研究进行了一个三级转诊医疗中心。对2012年1月至2016年12月期间所有测量血清乳酸和肌酐的成人艾德患者的病历进行了审查。根据急性肾损伤网络（AKIN）标准，将696例脓毒症患者分为阿基和非AKI组进行进一步的统计分析。结果：99例脓毒症患者（14.2%）患有阿基，其中AKIN-I，AKIN-II和AKIN-III分别占71.7%，11.1%和172%。与非MU组相比，MU组的死亡率显著更高（71.7% vs. 21.3%，p< 0.001）。脓毒性AM的独立危险因素包括肝脏疾病（校正比值比[AOR = 2.02，95%置信区间[CI = 1.16-352），糖尿病）（AOR = 1.73，95% CI = 1.11-2.69），慢性肾脏疾病（AOR = 1.68，95% CI = 1.06-2.66）和初始血清乳酸（AOR = 1.08，95% CI 1.02-1.14）。肝病、糖尿病和慢性肾脏疾病的合并症与脓毒性阿基相关，结合初始血清乳酸水平升高可预测艾德脓毒性患者的阿基和进一步死亡率。(C)2018爱思唯尔公司All rights reserved.
Background: Acute kidney injury (AKI) is a common complication in septic patients, imposing a heavy burden of illness in terms of morbidity and mortality. Serum lactate is a widely used marker predicting the severity of sepsis. A paucity of research has investigated septic AKI in emergency departments (EDs) and its correlation with initial serum lactate level. This study aimed at identifying risk factors for septic AKI and clarifying the link between initial scrum lactate level and septic AKI in ED patients.Methods: A retrospective cohort study was conducted at a single tertiary referral medical center. The medical records of all adult ED patients with measurement of serum lactate and creatinine between January 2012 and December 2016 were reviewed. A total of 696 septic patients were stratified into AKI and non-AKI groups according to Acute Kidney Injury Network (AKIN) criteria for further statistical analysis.Results: Ninety-nine septic patients (14.2%) had AKI, with AKIN-I, AKIN-II, and AKIN-III in 71.7%, 11.1%, and 172% of patients, respectively. Compared with the non-MU group, the MU group had a significantly higher mortality rate (71.7% vs. 21.3%, p< 0.001). Independent risk factors for septic AM included liver disease (adjusted odds ratio [AOR = 2.02, 95% confidence interval [CI = 1.16-352), diabetes mellitus (AOR = 1.73, 95% CI = 1.11-2.69), chronic kidney disease (AOR = 1.68, 95% CI = 1.06-2.66), and initial serum lactate (AOR = 1.08, 95% CI 1.02-1.14).Conclusions: Patients with septic AKI had an overwhelmingly higher mortality rate. The comorbidities of liver disease, diabetes mellitus, and chronic kidney disease were correlated with septic AKI and in combination with an elevated initial serum lactate level had predictive regarding AKI and further mortality in ED septic patients. (C) 2018 Elsevier Inc. All rights reserved.