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首页> 外文学位 >Hospital-acquired acute kidney injury: An analysis of nadir-to-peak serum creatinine increments stratified by baseline estimated GFR.
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Hospital-acquired acute kidney injury: An analysis of nadir-to-peak serum creatinine increments stratified by baseline estimated GFR.

机译：医院获得性急性肾损伤：基线估计的GFR分层的最低点至峰值血清肌酐增量分析。

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摘要

Background. Current working serum creatinine-based definitions of acute kidney injury (AKI) do not take into consideration the baseline level of kidney function, as defined by the estimated glomerular filtration rate (eGFR). The objective of this study was to explore whether the baseline eGFR should be taken into account when forming a definition of AKI.;Study design. Single-center retrospective cohort study.;Setting and participants. 29,645 adult subjects hospitalized at least once at an acute care hospital between 2000 and 2007.;Predictor. Hospital-acquired AKI was defined by calculating the difference between the peak and nadir serum creatinine. The nadir serum creatinine was ascertained in the first 3 days of the hospitalization, and was used to calculate the baseline eGFR, using the 4 variable MDRD Study equation.;Outcomes. In-hospital mortality, and among survivors, discharge disposition (to a facility vs. home).;Results. Different thresholds of serum creatinine were found to be independently associated with increased mortality according to different eGFR strata. Indeed, a nadir-to-peak serum creatinine of ≥ 0.2, ≥ 0.3 and ≥ 0.5 mg/dl were found to be associated with increased mortality in patients with baseline eGFR ≥ 60 (odds ratio [OR] 1.67; 95% confidence interval [CI] 1.13, 2.47), 30-59 (OR 2.69; 95% CI 1.82, 3.97), and 30 (OR 2.15; 95% CI 1.02, 4.51) ml/min/1.73 m2, respectively, after multivariable adjustment . There was a significant interaction of the nadir-to-peak serum creatinine and baseline eGFR strata for the outcome of in-hospital mortality (P 0.001), and among hospital survivors, with hospital discharge to facility (P 0.001). Sensivity analyses displayed similar results, with a significant interaction between eGFR strata and relative increases in serum creatinine, as well as with absolute and relative decreases in eGFR (P 0.001 for all analyses).;Limitations. Single center study; residual confounders; untimed definition of nadir-to-peak serum creatinine.;Conclusions. This study suggests that future development of serum creatinine-based definitions of AKI should take into consideration baseline kidney function.
机译：背景。当前基于血清肌酐的急性肾损伤（AKI）定义并未考虑肾功能的基线水平，这是由估计的肾小球滤过率（eGFR）定义的。这项研究的目的是探讨在形成AKI定义时是否应考虑基线eGFR。研究设计。单中心回顾性队列研究。背景和参与者。 2000年至2007年之间，有29,645名成人受试者至少在一次急诊医院住院过一次。通过计算峰值和最低血肌酐之间的差异来定义医院获得的AKI。在住院的前三天确定最低血清肌酐，并使用4个变量MDRD研究方程式将其用于计算基线eGFR。院内死亡率以及幸存者之间的出院情况（去设施还是住所）；结果。根据不同的eGFR分层，发现血清肌酐的不同阈值与死亡率增加独立相关。实际上，基线eGFR≥60的患者的最低血峰肌酐≥0.2，≥0.3和≥0.5 mg / dl与死亡率增加相关（优势比[OR] 1.67； 95％置信区间[多变量调整后，CI]分别为1.13、2.47），30-59（OR 2.69; 95％CI 1.82，3.97）和<30（OR 2.15; 95％CI 1.02，4.51）ml / min / 1.73 m2。医院内死亡率的结果（从峰值到峰值）的血清肌酐和基线eGFR层次之间存在显着的交互作用（P <0.001），并且在医院幸存者中，出院的情况也很明显（P <0.001）。敏感性分析显示相似的结果，eGFR层次与血清肌酐的相对增加之间存在显着的相互作用，eGFR的绝对和相对减少（所有分析均P <0.001）。单中心学习；残余混杂因素；血清肌酐从最低峰到峰值的不定时定义。这项研究表明，基于血清肌酐的AKI定义的未来发展应考虑基线肾功能。

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  • 作者

    Calvo Broce, Jose.;

  • 作者单位

    Sackler School of Graduate Biomedical Sciences (Tufts University).;

  • 授予单位 Sackler School of Graduate Biomedical Sciences (Tufts University).;
  • 学科 Health Sciences Medicine and Surgery.
  • 学位 M.S.
  • 年度 2010
  • 页码 24 p.
  • 总页数 24
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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