Costs and outcomes of acute kidney injury (AKI) following cardiac surgery
Costs and outcomes of acute kidney injury (AKI) following cardiac surgery
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DOI：
10.1093/ndt/gfm908
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发表时间：
2008-06-01
影响因子：
6.1
通讯作者：
Kellum, John A.
中科院分区：
文献类型：
--
作者：
Dasta, Joseph F.;Kane-Gill, Sandra L.;Kellum, John A.
背景资料。急性肾损伤(AKI)是公认的心脏手术并发症；然而，报道的费用和结果的差异在一定程度上是由于诊断和分类AKI的标准不同。我们确定了患者的成本、资源使用和死亡率。我们用步枪系统的血肌酐成分对AKI进行分型。从匹兹堡大学医学中心的电子数据库中对心脏手术后血清肌酐升高(<0.05 mg/dl)的患者进行了一项回顾性队列研究。数据与年龄和APACHE III匹配的对照组进行了比较。根据血肌酐的变化，确定三种步枪类别术后AKI患者的费用、死亡率和资源利用情况。在3741名入院患者中，有258人(6.9%)患有AKI，其中R型步枪138人(3.7%)，I型步枪70人(1.9%)，F50人(1.3%)。与对照组相比，AKI患者的总和科室水平的费用、住院时间(LOS)和肾脏替代治疗(RRT)的要求更高。在RIFLE-R、RIFLE-I和RIFLE-F三组患者中，所有费用、死亡率和RRT需求均有统计学差异。即使是血清肌酐变化最小的患者，即RIFLE-R，与对照组相比，死亡率增加2.2倍，ICU LOS增加1.6倍，术后总费用增加1.6倍。使用RIFLE标准进行AKI的心脏手术后患者的费用、LOS和死亡率较高，并且这些值随着AKI严重程度的恶化而增加。
Background. Acute kidney injury (AKI) is a recognized complication of cardiac surgery; however, the variability in costs and outcomes reported are due, in part, to different criteria for diagnosing and classifying AKI. We determined costs, resource use and mortality rate of patients. We used the serum creatinine component of the RIFLE system to classify AKI.Methods. A retrospective cohort study was conducted from the electronic data repository at the University of Pittsburgh Medical Center of patients who underwent cardiac surgery and had an elevation (>= 0.5 mg/dl) of serum creatinine postoperatively. Data were compared to age- and APACHE III-matched controls. Cost, mortality and resource use of AKI patients were determined postoperatively for each of the three RIFLE classes on the basis of changes in serum creatinine.Results. Of the 3741 admissions, 258 (6.9%) had AKI and were classified as RIFLE-R 138 (3.7%), RIFLE-I 70 (1.9%) and RIFLE-F 50 (1.3%). Total and departmental level costs, length of stay (LOS) and requirement for renal replacement therapy (RRT) were higher in AKI patients compared to controls. Statistically significant differences in all costs, mortality rate and requirement for RRT were seen in the patients stratified into RIFLE-R, RIFLE-I and RIFLE-F. Even patients with the smallest change in serum creatinine, namely RIFLE-R, had a 2.2-fold greater mortality, a 1.6-fold increase in ICU LOS and 1.6-fold increase in total postoperative costs compared to controls.Discussion. Costs, LOS and mortality are higher in postoperative cardiac surgery patients who develop AKI using RIFLE criteria, and these values increase as AKI severity worsens.