Prospective multicenter study on epidemiology of acute kidney injury in the ICU: a critical care nephrology Italian collaborative effort (NEFROINT).
Prospective multicenter study on epidemiology of acute kidney injury in the ICU: a critical care nephrology Italian collaborative effort (NEFROINT).
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关于 ICU 急性肾损伤流行病学的前瞻性多中心研究：意大利重症监护肾病学合作项目 (NEFROINT)。
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发表时间：
2011
影响因子：
3.2
通讯作者：
Investigators Nefroint
中科院分区：
文献类型：
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作者：
P. Piccinni;D. Cruz;S. Gramaticopolo;F. Garzotto;M. D. Santo;G. Aneloni;M. Rocco;E. Alessandri;F. Giunta;Michetti;M. Iannuzzi;C. B. Anello;N. Brienza;M. Carlini;P. Pelaia;Gabbanelli;C. Ronco;Investigators Nefroint
急性肾损伤（阿基）是危重症患者死亡的一个独立风险因素，过去由于各种研究中使用不同的定义，其流行病学尚不清楚。步枪共识定义为阿基提供了一个统一的定义，从而在不同国家开展了大型回顾性研究。本研究是一项前瞻性观察性多中心研究，旨在前瞻性评价意大利10个重症监护室（ICU）的所有住院事件和阿基的相关流行病学。创建了一个简单的用户友好的基于网络的数据收集工具，其范围为本研究服务，并促进未来的多中心协作工作。我们入组了601例连续患者，排除了25例终末期肾病患者，留下576例患者进行分析。中位年龄为66岁（IQR 53-76），59.4%为男性，而中位SAPS II和APACHE II评分分别为43（IQR 35-54）和18（IQR 13-24）。ICU入院最常见的诊断类别是：呼吸系统（27.4%），其次是神经系统（17%）、创伤（14.4%）和心血管系统（12.1%）。ICU和住院死亡率为21.7%，ICU中位住院时间为5天（IQR 3，14）。在576例患者中，246例患者（42.7%）在入住ICU后24小时内发生阿基，而133例患者在入住ICU后发生了新的阿基。RIFLE初始分类为风险205例（54.1%），损伤99例（26.1%），失败75例（19.8%）。在114例患者（30.8%的阿基患者）中观察到阿基进展为更严重的步枪分级。阿基患者年龄较大，常见危险因素发生频率较高。116名阿基患者（30.6%）在ICU住院期间符合败血症标准，而非AKI患者为33名（16.7%）（P<0.001）。48例患者（8.3%）在ICU接受肾脏替代治疗（RRT）。患者在ICU入院后中位数2（IQR 0-6）天开始RRT。在阿基患者中，他们在符合阿基标准后中位数1（IQR 0-4）天开始接受RRT。RRT的中位持续时间为5（IQR 2-10）天。阿基患者的ICU粗死亡率更高（28.8% vs.非AKI 8.1%，P<0.001），ICU住院时间更长（中位数7天vs. 3天[非AKI]，P<0.001）。ICU粗死亡率和ICU住院时间随阿基严重程度的增加而增加。225例患者（59.4%的阿基患者）肾功能完全恢复，ICU出院时SCr ≤基线的120%;另外51例阿基患者（13.5%）肾功能部分恢复，而103例（27.2%）在死亡或ICU出院时肾功能未恢复。脓毒症患者的阿基更严重，更有可能接受RRT，肾功能恢复的频率更低。脓毒症患者的ICU死亡率较高，ICU停留时间较长。该研究证实了先前的分析，将步枪描述为阿基严重程度分期的最佳分类系统。阿基确实是ICU患者的致命并发症，其严重程度与死亡率和住院时间相关。为数据收集而开发的工具便于用户使用，易于实施。它的一些功能，包括步枪类警报系统，可以帮助治疗医生系统地收集ICU中的阿基数据，并可能指导肾脏替代治疗机构的具体决策。
Acute kidney injury (AKI) is an independent risk factor for mortality in critically ill patients whose epidemiology has been made unclear in the past by the use of different definitions across various studies. The RIFLE consensus definition has provided a unifying definition for AKI leading to large retrospective studies in different countries. The present study is a prospective observational multicenter study designed to prospectively evaluate all incident admissions in 10 Intensive Care Units (ICUs) in Italy and the relevant epidemiology of AKI. A simple user-friendly web-based data collection tool was created with the scope to serve for this study and to facilitate future multicenter collaborative efforts. We enrolled 601 consecutive patients into the study; 25 patients with End-Stage Renal Disease were excluded leaving 576 patients for analysis. The median age was 66 (IQR 53-76) years, 59.4% were male, while median SAPS II and APACHE II scores were 43 (IQR 35-54) and 18 (IQR 13-24), respectively. The most common diagnostic categories for ICU admission were: respiratory (27.4%), followed by neurologic (17%), trauma (14.4%), and cardiovascular (12.1%). Crude ICU and hospital mortality were 21.7% and median ICU length of stay was 5 days (IQR 3, 14). Of 576 patients, 246 patients (42.7%) had AKI within 24 hours of ICU admission while 133 developed new AKI later during their ICU stay. RIFLE-initial class was Risk in 205 patients (54.1%), Injury in 99 (26.1%) and Failure in 75 (19.8%). Progression of AKI to a worse RIFLE class was seen in 114 patients (30.8% of AKI patients). AKI patients were older, with higher frequency of common risk factors. 116 AKI patients (30.6%) fulfilled criteria for sepsis during their ICU stay, compared to 33 (16.7%) of non-AKI patients (P<0.001). 48 patients (8.3%) were treated with renal replacement therapy (RRT) in the ICU. Patients were started on RRT a median of 2 (IQR 0-6) days after ICU admission. Among AKI patients, they were started on RRT a median of 1 (IQR 0-4) days after fulfilling criteria for AKI. Median duration of RRT was 5 (IQR 2-10) day. AKI patients had a higher crude ICU mortality (28.8% vs. non-AKI 8.1%, P<0.001) and longer ICU length of stay (median 7 days vs. 3 days [non-AKI], P<0.001). Crude ICU mortality and ICU length of stay increased with greater severity of AKI. Two hundred twenty five patients (59.4% of AKI patients) had complete recovery of renal function, with a SCr at time of ICU discharge which was ≤120% of baseline; an additional 51 AKI patients (13.5%) had partial renal recovery, while 103 (27.2%) had not recovered renal function at the time of death or ICU discharge. Septic patients had more severe AKI, and were more likely to receive RRT with less frequency of renal function recovery. Patients with sepsis had higher ICU mortality and longer ICU stay. The study confirms previous analyses describing RIFLE as an optimal classification system to stage AKI severity. AKI is indeed a deadly complication for ICU patients where the level of severity correlated with mortality and length of stay. The tool developed for data collection resulted user friendly and easy to implement. Some of its features including a RIFLE class alert system, may help the treating physician to collect systematically AKI data in the ICU and possibly may guide specific decision on the institution of renal replacement therapy.