Acetaminophen administration and the risk of acute kidney injury: a self-controlled case series study.
Acetaminophen administration and the risk of acute kidney injury: a self-controlled case series study.
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DOI：
10.2147/clep.s158110
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发表时间：
2018
影响因子：
3.9
通讯作者：
Kuroda T
中科院分区：
文献类型：
--
作者：
Hiragi S;Yamada H;Tsukamoto T;Yoshida K;Kondo N;Matsubara T;Yanagita M;Tamura H;Kuroda T
对乙酰氨基酚（APAP）经常用于镇痛，被认为比非甾体抗炎药（NSAIDs）对肾脏更安全。然而，很少有流行病学证据表明APAP与急性肾损伤（AKI）之间存在关联。使用自我控制病例序列（SCCS）方法检查APAP和AKI之间的关系，SCCS是一种通过比较每个患者的风险和参考期来控制人与人之间混杂因素的新策略。通过回顾2011年5月至2016年7月电子存储的医院信息系统数据，我们对1871名接受APAP治疗并随后发展为AKI的患者（39.9%为女性）进行了SCCS。我们使用条件泊松回归来比较每个患者的风险和参照期。作为一个时变混杂因素，我们调整了肝肾功能、全身炎症和非甾体抗炎药暴露的状态。在260,549人/天的观察期内，我们确定了5650例AKI事件。参考期和暴露期未调整的发病率分别为2.01/100和3.12/100人日。经SCCS校正后的发病率比为1.03（95%可信区间[CI]: 0.95-1.12）。当我们将终点限制为2期AKI和3期AKI水平肌酐升高时，发病率比分别为1.20 （95% CI 0.91-1.58）和1.20 (95% CI 0.62-2.31)，两者均无统计学意义。我们的发现为APAP使用与AKI发展之间的关系提供了流行病学信息。结果显示APAP与AKI之间的相关性很低，这可能支持了一般医生认为APAP对肾脏更安全的印象。
Acetaminophen (APAP) is frequently used for analgesia and is considered safer than nonsteroidal anti-inflammatory drugs (NSAIDs) for the kidneys. However, there is little epidemiological evidence of the association between APAP and acute kidney injury (AKI). To examine the association between APAP and AKI using the self-controlled case series (SCCS) method, which is a novel strategy to control between-person confounders by comparing the risk and reference periods in each patient. We performed SCCS in 1,871 patients (39.9% female) who were administered APAP and subsequently developed AKI, by reviewing electronically stored hospital information system data from May 2011 to July 2016. We used conditional Poisson regression to compare each patient’s risk and reference period. As a time-varying confounder, we adjusted the status of liver and kidney functions, systemic inflammation, and exposure to NSAIDs. We identified 5,650 AKI events during the 260,549 person-day observation period. The unadjusted incidences during the reference and exposure periods were 2.01/100 and 3.12/100 person-days, respectively. The incidence rate ratio adjusted with SCCS was 1.03 (95% confidence interval [CI]: 0.95–1.12). When we restricted endpoints as stage 2 AKI- and stage 3 AKI-level creatinine elevations, the incidence rate ratios were 1.20 (95% CI 0.91–1.58) and 1.20 (95% CI 0.62–2.31), respectively, neither of which was statistically significant. Our findings added epidemiological information for the relationship between APAP administration and AKI development. The results indicated scarce association between APAP and AKI, presumably supporting the general physicians’ impression that APAP is safer for kidney.