Predictors of acute kidney injury and mortality in an Intensive Care Unit

Introduction and Objectives: To compare clinical characteristics and outcomes of patients with and without acute kidney injury (AKI), to evaluate the incidence and mortality of AKI and predictors of AKI and death in patients hospitalized in an Intensive Care Unit (ICU). Methods: A retrospective study analyzed 152 patients admitted to a single ICU. We assessed age, gender, reason for hospitalization, risk factors for ARF, laboratory data, the need for renal therapy substitutive and mortality. Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA) and RIFLE were recorded on the day of ICU admission. We determined the incidence of AKI, mortality and the independent predictors of AKI and death using logistic regression model. Results: Mean age was 57.1 ± 20 years, ranging between 19 to 88 years, and 60.1% were male. Non-dialysis dependent AKI occurred in 81 patients (53.2%) while the ARF requiring dialysis occurred in 19 patients (12.4%). The overall mortality rate in the ICU was 35.9%, whereas the mortality rate in patients with non-dialysis dependent AKI was 43.2% and the IRA with dialysis of 84.2%. In multivariate analysis, invasive mechanical ventilation, elevated creatinine and urea at admission were independent risk factors for AKI, whereas clinical diagnosis, invasive mechanical ventilation, increased lactate and urea and hypernatremia were independent risk factors for ICU mortality. Conclusion: The incidence and mortality of AKI in ICU were high in this study, despite the advances that have been emerging in their management.

引言与研究目标：本研究旨在对比伴与不伴急性肾损伤（AKI，acute kidney injury）患者的临床特征与结局，评估重症监护病房（ICU，Intensive Care Unit）住院患者中AKI的发病率、死亡率，以及AKI与死亡的预测因素。研究方法：本研究为回顾性研究，分析了某单一ICU收治的152例患者。我们评估了患者年龄、性别、住院病因、急性肾衰竭（ARF，acute renal failure）危险因素、实验室检查数据、肾脏替代治疗需求及死亡率。于ICU入院当日记录急性生理学与慢性健康状况评分系统Ⅱ（APACHE II，Acute Physiology and Chronic Health Evaluation II）、序贯器官衰竭评估（SOFA，Sequential Organ Failure Assessment）及RIFLE标准。采用logistic回归模型，明确AKI的发病率、死亡率，以及AKI与死亡的独立预测因素。研究结果：本研究纳入患者的平均年龄为57.1±20岁，年龄范围为19~88岁，其中男性占比60.1%。81例患者（53.2%）发生非透析依赖型AKI，19例患者（12.4%）罹患需透析治疗的急性肾衰竭。本研究的ICU总体死亡率为35.9%，非透析依赖型AKI患者的死亡率为43.2%，需透析治疗的急性肾衰竭患者死亡率为84.2%。多因素logistic回归分析显示，有创机械通气、入院时肌酐与尿素水平升高是AKI发生的独立危险因素；而临床诊断、有创机械通气、乳酸与尿素水平升高及高钠血症是ICU患者死亡的独立危险因素。研究结论：尽管当前AKI的诊疗手段不断取得进展，但本研究显示ICU患者中AKI的发病率与死亡率仍处于较高水平。