住院患者急性肾损伤的流行病学、轨迹与结局：一项回顾性多中心大样本队列研究
Epidemiology, Trajectories and Outcomes of Acute Kidney Injury Among Hospitalized Patients: A Retrospective Multicenter Large Cohort Study
AI总结：
本研究基于OneFlorida+网络的大样本队列，分析三类AKI轨迹对住院患者临床结局的影响，发现持续性AKI患者预后更差、医疗资源消耗更高，为AKI分层管理与持续进展预防提供了循证依据。
摘要：
研究背景：急性肾损伤（AKI）是一种临床综合征，影响近五分之一的住院患者，以及超过半数的重症监护室（ICU）收治患者。根据严重程度和持续时间对AKI患者进行分层，将有助于开展更具针对性的AKI治疗工作。\n研究方法：本研究为回顾性多中心纵向队列研究，纳入2012年至2020年间OneFlorida+网络（佛罗里达医疗数据协作网络）下属医疗中心收治的935679名患者，分析了三类AKI轨迹对患者临床结局的影响，三类轨迹分别为快速逆转型AKI、伴肾功能恢复的持续性AKI、不伴肾功能恢复的持续性AKI；评估的临床结局包括住院死亡率、30天死亡率、1年死亡率、3年死亡率、肾脏替代治疗情况、出院后90天或1年内新发慢性肾脏病（CKD）情况、出院后1年内CKD进展情况、医疗资源利用情况、出院去向以及住院期间主要并发症。分析方法采用Kaplan-Meier估计量与生存曲线、Cox比例风险回归模型、logistic回归模型、Kruskal-Wallis检验、方差分析、卡方检验、Fisher精确检验。\n研究结果：在2187254次就诊记录中，14%的就诊发生AKI，其中AKI最高分期为1期、2期、3期的患者占比分别为63%、21%、16%。持续性AKI患者占比为31%。与未患AKI的患者相比，AKI患者的临床结局更差，医疗资源利用量更高。持续性AKI患者的1年死亡率是未患AKI患者的5倍。\n研究结论：与其他组别相比，持续性AKI与住院时间延长、ICU收治率升高及死亡率上升相关。这一结果凸显了制定针对性策略以实现AKI有效管理、预防AKI持续进展的迫切需求。
英文摘要：
Background: Acute kidney injury (AKI) is a clinical syndrome affecting almost one fifth of hospitalized patients, as well as more than half of the patients who are admitted to the intensive care unit (ICU). Stratifying AKI patients into groups based on severity and duration would facilitate more targeted efforts for treating AKI. Methods: In a retrospective, multicenter and longitudinal cohort study of 935,679 patients who were admitted between 2012 and 2020 to health centers included in OneFlorida+ Network, we analyzed the impact of AKI trajectories which are rapidly reversed AKI, persistent AKI with renal recovery, and persistent AKI without renal recovery on patients' clinical outcomes, including hospital, 30-day, 1-year, and 3-year mortality, kidney replacement therapy, new chronic kidney disease (CKD) within 90 days or 1-year of discharge, CKD progression within 1-year of discharge, resource utilization, hospital disposition, and major complications during hospitalization. As analytical approaches, Kaplan-Meier estimators and survival curves, Cox proportional-hazards regression model, logistic regression model, Kruskal-Wallis test, analysis of variance, chi-square, Fisher's exact test were used. Results: Among 2,187,254 encounters, 14% had AKI, of which 63%, 21%, and 16% had Stage 1, 2, and 3, respectively, as the worst AKI stage. Fraction of patients with persistent AKI was 31%. Patients with AKI had worse clinical outcomes and increased resource utilization compared to patients without the condition. One-year mortality was 5 times greater for patients with persistent AKI compared to those without AKI. Conclusions: Persistent AKI was associated with prolonged hospitalization, increased ICU admission and mortality compared to the other groups. This may emphasize the critical need for devising strategies targeting effective management of AKI and prevention of persisting AKI.
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