ICM:根据重症监护室入院时急性肾损伤严重程度划分的健康结局：一项基于人群的队列研究

Abstract

Purpose: The presence and severity of acute kidney injury (AKI) upon ICU admission provides important short- and long-term prognostic information. Existing reports have been limited by inadequate baseline kidney function assessment, incomplete outcome capture, limited adjustment for illness severity, and small sample sizes.

目的：重症监护室（ICU）入院时急性肾损伤（AKI）的存在及严重程度可为短期和长期预后提供重要信息。现有研究因基线肾功能评估不足、结局数据收集不完整、疾病严重程度调整有限以及样本量较小而存在局限。

Methods: We conducted a population-level study of all adult (≥ 18 years) Ontario, Canada residents with available outpatient baseline creatinine measurements admitted to the ICU from 2009-2021. AKI at the time of ICU admission was determined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Outcomes included death and kidney replacement therapy (KRT). Multivariable logistic regression modeling was used to estimate adjusted odds ratios (aOR).

方法：我们对加拿大安大略省所有年龄≥18岁、有可用门诊基线肌酐测量值并在2009—2021年间入住ICU的居民开展了一项人群水平研究。ICU入院时的AKI根据《改善全球肾脏病预后组织》（KDIGO）标准判定。主要结局包括死亡和肾脏替代治疗（KRT）。采用多变量逻辑回归模型估计调整后的比值比（aOR）。

结果：研究队列共纳入484,956名成人（43%为女性）ICU患者。平均（标准差）年龄和基线估算肾小球滤过率（eGFR）分别为68（15）岁和77（25）mL/min/1.73 m²。其中105,671人（22%）存在AKI。与无AKI相比，1期AKI患者90天死亡风险约增加一倍（aOR 1.89，95%置信区间[1.85–1.93]）；2期和3期AKI患者死亡风险约增加2.5倍（2期aOR 2.64，95% CI[2.54–2.73]；3期aOR 2.54，95% CI[2.45–2.63]）。与无AKI相比，90天时对KRT依赖的风险随AKI分期升高而逐步增加：1期（aOR 2.05，95% CI[1.79–2.34]）、2期（aOR 4.28，95% CI[3.40–5.40]）和3期（aOR 8.61，95% CI[7.71–9.62]）。

Conclusion: The presence and severity of AKI at the time of ICU admission are strongly associated with adverse health outcomes. Stage 2 and 3 AKI portend a similarly high risk of mortality. 

结论：ICU入院时AKI的存在及其严重程度与不良健康结局密切相关。2期和3期AKI预示相似的极高死亡风险。