Acute kidney injury risk assessment at the hospital front door: what is the best measure of risk?
Acute kidney injury risk assessment at the hospital front door: what is the best measure of risk?
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DOI：
10.1093/ckj/sfv080
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发表时间：
2015-12
影响因子：
4.6
通讯作者：
Phillips A
中科院分区：
文献类型：
--
作者：
Roberts G;Phillips D;McCarthy R;Bolusani H;Mizen P;Hassan M;Hooper R;Saddler K;Hu M;Lodhi S;Toynton E;Geen J;Lodhi V;Grose C;Phillips A
我们检查了急诊医疗单位中急性肾损伤（阿基）危险因素的患病率，生成了一个修改后的风险评估工具，并测试了其预测阿基的能力。共对1196例住院患者进行了患者相关阿基风险因素评估。随后，对898例患者进行了有限数量的固定风险因素评估，并增加了低血压和脓毒症。这与阿基事件相关。在第一个队列中，阿基风险因素的患病率为每例患者2.1 ± 2.0，年龄与风险因素数量呈正相关，≥65岁患者的风险因素数量更高。在第二个队列中，12.3%的患者出现或发展为阿基。阿基患者年龄较大，阿基风险因素较多。在阿基队列中，72%的患者有两个或两个以上的阿基风险因素，而无阿基的队列中有43%。当年龄≥65岁作为一个独立的风险因素时，84%的阿基患者有两个或两个以上的阿基风险因素，而无阿基的患者为55%。受试者操作特征分析表明，使用常见的患者相关已知阿基风险因素作为阿基的预测因子并不比单独使用年龄更好。对已确定的患者相关阿基风险因素进行详细评估可能不利于临床医生分配风险。这表明，需要开展额外的工作来开发一种更灵敏、经验证的AKI预测工具，这种工具在这种临床环境中是有用的。
We examined the prevalence of acute kidney injury (AKI) risk factors in the emergency medical unit, generated a modified risk assessment tool and tested its ability to predict AKI. A total of 1196 patients admitted to medical admission units were assessed for patient-associated AKI risk factors. Subsequently, 898 patients were assessed for a limited number of fixed risk factors with the addition of hypotension and sepsis. This was correlated to AKI episodes. In the first cohort, the prevalence of AKI risk factors was 2.1 ± 2.0 per patient, with a positive relationship between age and the number of risk factors and a higher number of risk factors in patients ≥65 years. In the second cohort, 12.3% presented with or developed AKI. Patients with AKI were older and had a higher number of AKI risk factors. In the AKI cohort, 72% of the patients had two or more AKI risk factors compared with 43% of the cohort with no AKI. When age ≥65 years was added as an independent risk factor, 84% of those with AKI had two or more AKI risk factors compared with 55% of those with no AKI. Receiver operating characteristic analysis suggests that the use of common patient-associated known AKI risk factors performs no better than age alone as a predictor of AKI. Detailed assessment of well-established patient-associated AKI risk factors may not facilitate clinicians to apportion risk. This suggests that additional work is required to develop a more sensitive validated AKI-predictive tool that would be useful in this clinical setting.