One-year mortality in critically ill patients by severity of kidney dysfunction: A population-based assessment
One-year mortality in critically ill patients by severity of kidney dysfunction: A population-based assessment
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DOI：
10.1053/j.ajkd.2006.06.002
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发表时间：
2006-09-01
影响因子：
13.2
通讯作者：
Laupland, Kevin B.
中科院分区：
文献类型：
--
作者：
Bagshaw, Sean M.;Mortis, Garth;Laupland, Kevin B.
背景：重症监护病房（ICU）肾功能不全导致发病率、死亡率和医疗费用增加；然而，肾功能不全严重程度的长期死亡率还没有被描述。方法：主要目的是描述和评估ICU住院期间按肾功能不全严重程度分层的危重患者1年死亡率的相关因素。肾功能障碍由血清肌酐峰值值定义，并按以下标准分层：(1)无功能障碍（肌酐< 1.7 mg/dL [= 3.4 mg/dL [>= 300 mu mol/L]），(4)严重急性功能障碍需要肾脏替代治疗（急性肾功能衰竭），或(5)既往存在终末期肾脏疾病。以人口为基础的监测对象是1999年5月1日至2002年4月30日期间入住任何多学科ICU和心血管外科ICU的卡尔加里卫生区成年居民（人口100万）。结果：在5693例入院患者中，62%为男性，中位年龄为64.9岁（四分位数范围为50.6至74.5岁），急性生理和慢性健康评估（APACHE） II平均评分为24.9 +/- 8.7 （SD）。按肾功能不全分层的病死率分别为17%（4411例中763例）、47%（790例中370例）、48%（160例中77例）、64%（240例中153例）和40%（92例中37例）；严重急性肾功能衰竭；和终末期肾病。通过多因素分析，1年死亡率与年龄增长、医学诊断、较高的APACHE II评分、肾功能不全的存在和严重程度独立相关，但与轻度和中度肾功能不全的患者相比无明显差异。终末期肾病与1年死亡率无独立相关性。结论：ICU患者肾功能不全的严重程度与长期死亡率的增加相关。尽管轻度或中度肾功能不全的患者死亡风险增加，但单独使用血清肌酐水平在区分长期预后方面效果较差，提示不应单独使用该指标来确定长期预后。
Background: Kidney dysfunction in the intensive care unit (ICU) results in increased morbidity, mortality, and health care costs; however, long-term mortality has not been described across strata of severity in kidney dysfunction. Methods: The primary objective is to describe and assess factors associated with 1-year mortality in critically ill patients stratified by severity of kidney dysfunction during admission to the ICU. Kidney dysfunction is defined by peak serum creatinine values and stratified by: (1) no dysfunction (creatinine < 1.7 mg/dL [= 3.4 mg/dL [>= 300 mu mol/L]), (4) severe acute dysfunction requiring renal replacement therapy (acute renal failure), or (5) preexisting end-stage kidney disease. Population-based surveillance was of adult residents of the Calgary Health Region (population, I million) admitted to any multidisciplinary ICU and a cardiovascular surgery ICU from May 1, 1999, to April 30,2002. Results: Of 5,693 admissions, 62% were men, median age was 64.9 years (Interquartile range, 50.6 to 74.5 years), and mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 24.9 +/- 8.7 (SD). Case fatality rates stratified by renal dysfunction were 17% (763 of 4,411), 47% (370 of 790),48% (77 of 160), 64% (153 of 240), and 40% (37 of 92) for no, mild, and moderate dysfunction; severe acute renal failure; and end-stage kidney disease, respectively. By means of multivariate analysis, 1-year mortality was associated independently with advancing age, medical diagnosis, higher APACHE II score, and presence and severity of kidney dysfunction, although no difference was evident comparing those with mild to moderate dysfunction. End-stage kidney disease was not associated independently with 1-year mortality. Conclusion: Severity of kidney dysfunction in patients in the ICU is associated with an incremental increase in long-term mortality. Although patients classified with either mild or moderate kidney dysfunction had an increased risk for death, use of serum creatinine level alone was poor at discriminating long-term outcome, suggesting this measure alone should not be used for defining long-term prognosis.