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41卷第2期
基于电子监控系统的住院患者急性肾损伤研究
Incidence and outcome of acute kidney injury in hospitalized patients by an electronic alert
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DOI:
作者:
蒋啸天,胡家昌 ,许佳瑞,姜物华,沈波,方艺,滕 杰,丁小强,王一梅
作者单位:
复旦大学附属中山医院肾内科,上海市肾脏疾病临床医学中心,上海市肾病与透析研究所,上海市肾脏疾病与血液净化重点实验室
关键词:
急性肾损伤;电子监控系统;发病率;死亡率
Acute kidney injury;Electronic alerts;Incidence;Mortality
摘要:
目的 建立电子监控系统(E-Alerts),掌握住院患者急性肾损伤(AKI)的发病情况及其预后,以期降低AKI患者的发病率和死亡率。方法 选取2014年10月1日~2015年9日30日于复旦大学附属中山医院住院的99847例成年(年龄≥18岁)患者,按照改善全球肾脏病预后组织(KDIGO)标准,通过E-Alerts筛选出AKI患者9898例(9.9%),并将其分为1、2和3期,随访AKI患者预后,并分析其危险因素。结果 AKI患者中男性6536例,女性3362例,平均年龄(64.14±17.19)岁,51.4%来自外科,47.4%来自内科,1.2%来自妇产科,院内死亡563例(5.7%)。AKI 1、2、3期和肾脏替代治疗发病率分别为8.0%、0.7%、1.2%和0.5%,院内死亡率分别为4.1%、11.2%、13.7%和19.5%。3747例(37.9%)患者为社区获得性AKI(CA-AKI),6151例(62.1%)为医院获得性AKI(HA-AKI)。HA-AKI患者的年龄显著大于CA-AKI患者(P<0.001),住院天数、住院费用和死亡率显著高于非AKI患者(P<0.001)。AKI患者中仅有773例(7.8%)邀请肾内科医师会诊,出院诊断包含AKI相关诊断者仅121例(1.2%)。多因素logistic回归显示年龄、AKI分期、HA-AKI、肾脏替代治疗、恶性肿瘤、心力衰竭、低白蛋白血症和贫血是AKI患者死亡的独立危险因素。结论 住院患者AKI的发病率高,AKI患者住院天数显著延长,住院费用和死亡率显著升高。广大医师对AKI认识不足,漏诊严重,肾内科会诊率低。电子监控和智能决策系统的建立,肾内科医师的积极介入,对提高AKI防诊治水平,改善患者预后具有极其重要的作用。
Objectives This study was to establish an electronic alert system and determine the incidence and mortality rate of acute kidney injury (AKI) among hospitalized adult patients in a tertiary metropolitan hospital of China. Methods Patients from Zhongshan Hospital, Fudan University, Shanghai, China between October 1st, 2014 and September 30th, 2015 were screened by the hospital medical database. The presence and severity of AKI were assessed by the KDIGO criteria. AKI patients were distinguished by electronic alerts. Results There were 99847 patients during the study period and 9898(9.9%) met the diagnostic criteria of AKI. The median age of AKI patients was 64 years, 66% were male, 5.2%(510/9898) received renal replacement therapy (RRT). 51.4% of AKI patients came from surgical department, 47.4% from internal medicine, and 1.2% from obstetrics and gynecology. Community acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI) accounted for 37.9% and 62.1% respectively. The AKI group had significantly longer length of stay(LOS) and higher mortality than the non AKI group. Only 7.8% of AKI patients received nephrology consultation and 1.2% was recorded in discharge diagnosis. Multivariate logistic regression showed that age, AKI stage, HA-AKI, RRT, heart failure, malignancy, hypoalbuminemia and anemia were independent risk factors of in-hospital mortality of AKI patients. Conclusion AKI is prevalent in the hospitalized patients with serious misdiagnosis and low nephrology consultation rate. Slight elevations of serum creatinine are associated with significantly increased mortality, LOS and hospital cost. The establishment of AKI electronic alerts and active intervention of nephrologists can significantly increase the recognition of AKI patients and may help prevent AKI and improve the prognosis of AKI patients.
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