Long-Term Risk of Mortality and Acute Kidney Injury During Hospitalization After Major Surgery
Long-Term Risk of Mortality and Acute Kidney Injury During Hospitalization After Major Surgery
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DOI：
10.1097/sla.0b013e3181a40a0b
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发表时间：
2009-05-01
影响因子：
9
通讯作者：
Segal, Mark S.
中科院分区：
文献类型：
--
作者：
Bihorac, Azra;Yavas, Sinan;Segal, Mark S.
目的：探讨大手术后住院期间长期死亡率与急性肾损伤(AKI)的关系。摘要背景数据：AKI与短期死亡风险成正比，但AKI患者的长期存活率研究较少。方法：这是一项回顾性队列研究，研究对象为1992-2002年间无慢性肾脏病病史的10,518名患者。AKI是由RIFLE(风险、损伤、失败、丢失和终末期肾脏)分类定义的，该分类要求血清肌酐(SCr)至少增加50%，并将患者分为三个严重阶段：风险、损伤和失败。患者的存活率通过全国社会保障死亡指数来确定。结果：在风险调整模型中，与未发生急性肾损伤的患者相比，发生急性心肌梗死的患者存活率较低，且与病情严重程度成正比，步枪风险类患者的调整风险比为1.18(95%可信区间，1.08~1.29)，步枪失败类患者的调整风险比为1.57(95%可信区间，1.40~1.75)(P<；0.001)。与未发生急性肾损伤的患者相比，急性肾损伤后肾功能完全恢复的患者死亡的调整风险比仍增加1.2(95%CI，1.10-1.31)(P<；0.001)。结论：在大手术后出院的大型单中心队列患者中，急性肾损伤患者住院期间Scr水平的微小变化与独立的长期死亡风险相关。
Objective: To determine the relationship between long-term mortality and acute kidney injury (AKI) during hospitalization after major surgery.Summary Background Data: AKI is associated with a risk of short-term mortality that is proportional to its severity; however the long-term survival of patients with AKI is poorly Studied.Methods: This is a retrospective cohort study of 10,518 patients with no history of chronic kidney disease who were discharged after a major surgery between 1992 and 2002. AKI was defined by the RIFLE (Risk, Injury, Failure, Loss, and End-stage Kidney) classification, which requires at least a 50% increase in serum creatinine (sCr) and stratifies patients into 3 severity stages: risk, injury, and failure. Patient survival was determined through the National Social Security Death Index. Long-term survival was analyzed using a risk-adjusted Cox proportional hazards regression model.Results: In the risk-adjusted model, survival was worse among patients with AKI and was proportional to its severity with an adjusted hazard ratio of 1.18 (95% confidence interval [CI], 1.08-1.29) for the RIFLE-Risk class and 1.57 (95% Cl, 1.40-1.75) for the RIFLE-Failure class, compared with patients without AKI (P < 0.001). Patients with complete renal recovery after AKI still had an increased adjusted hazard ratio for death of 1.20 (95% Cl, 1.10-1.31) compared with patients without AKI (P < 0.001).Conclusions: In a large single-center cohort of patients discharged after major surgery, AKI with even small changes in sCr level during hospitalization was associated with an independent long-term risk of death.