عنوان مقاله
نارسایی حاد کلیه، مرگ و میر، طول مدت اقامت و هزینه بستری در بیماران
فهرست مطالب
چکیده
مقدمه
مواد و روش ها
نتایج
بحث و گفتگو
بخشی از مقاله
تجزیه و تحلیل آماری
متغیرهای پیوسته به عنوان میانگین ±SD یا متوسط با دامنه ی میان چارکی و در مقایسه با آزمون t و یا آزمون مجموع امتیازاتWilcoxon ، در زمان مناسب توصیف شده است. متغیرهای قطعی به عنوان نسبت و در مقایسه با آزمون𝜒^2 تعریف شده اند. ما از رگرسیون لجستیک برای تخمین احتمال مرگ با AKI، تنظیم برای همراهی با سن، جنس، وزن DRG، گروه ICD-9-CM، و CKD استفاده کردیم. از آنجا که مرگ در میان بیماران مبتلا به افزایش بزرگ در SCR نسبتا شایع بود، میزان خطر با استفاده از روش Zhang و Yu (6) برآورد شد.
کلمات کلیدی:
Acute Kidney Injury, Mortality, Length of Stay, and Costs in Hospitalized Patients Glenn M. Chertow,* Elisabeth Burdick,† Melissa Honour,† Joseph V. Bonventre,‡ and David W. Bates† *Division of Nephrology, Departments of Medicine, Epidemiology, and Biostatistics, University of California San Francisco, San Francisco, California; † Division of General Internal Medicine and ‡ Renal Division, Department of Medicine and Harvard-MIT Division of Health Sciences and Technology, Brigham and Women’s Hospital, Harvard Medical School, Partners HealthCare System, Boston, Massachusetts The marginal effects of acute kidney injury on in-hospital mortality, length of stay (LOS), and costs have not been well described. A consecutive sample of 19,982 adults who were admitted to an urban academic medical center, including 9210 who had two or more serum creatinine (SCr) determinations, was evaluated. The presence and degree of acute kidney injury were assessed using absolute and relative increases from baseline to peak SCr concentration during hospitalization. Large increases in SCr concentration were relatively rare (e.g., >2.0 mg/dl in 105 [1%] patients), whereas more modest increases in SCr were common (e.g., >0.5 mg/dl in 1237 [13%] patients). Modest changes in SCr were significantly associated with mortality, LOS, and costs, even after adjustment for age, gender, admission International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis, severity of illness (diagnosis-related group weight), and chronic kidney disease. For example, an increase in SCr >0.5 mg/dl was associated with a 6.5-fold (95% confidence interval 5.0 to 8.5) increase in the odds of death, a 3.5-d increase in LOS, and nearly $7500 in excess hospital costs. Acute kidney injury is associated with significantly increased mortality, LOS, and costs across a broad spectrum of conditions. Moreover, outcomes are related directly to the severity of acute kidney injury, whether characterized by nominal or percentage changes in serum creatinine. J Am Soc Nephrol 16: 3365–3370, 2005. doi: 10.1681/ASN.2004090740 Acute kidney injury (AKI) has been reported in 5 to 7% of hospitalized patients on the basis of several singlecenter reports (1,2). Despite the perception that AKI is relatively common, there is no uniform definition for AKI, and relatively few data regarding its incidence in hospitalized patients are available. Moreover, the relative effects of AKI on mortality, hospital length of stay (LOS), and costs have not been well described. Most studies that have explored downstream effects of AKI have either considered AKI requiring dialysis or homogenous patient populations, such as those who were exposed to radiocontrast agents or undergoing cardiothoracic surgery. In the context of a computer-based intervention in which data were collected on kidney function, severity of illness, drug prescription, and outcomes in hospitalized patients (3), we linked changes in serum creatinine (SCr) with in-hospital mortality, LOS, and costs. We hypothesized that relatively small changes in SCr would be common and associated with adverse outcomes, even after adjustment for severity of disease. Materials and Methods Study Setting The study was conducted at Brigham and Women’s Hospital, a 720-bed urban academic medical center in Boston, MA. Data were obtained for a study to examine the effects of a computer-order entrybased decision tool on drug prescribing for hospitalized patients with impaired kidney function (3). As part of the data library collected for evaluation of the appropriateness of drug prescription, serial SCr determinations were collected on a consecutive series of hospitalized patients on the medical, surgical (including subspecialty surgical services), neurology, and obstetrics and gynecology services between September 1997 and April 1998. There were 19,982 admissions in which at least one SCr was obtained. For 9210 (46%) admissions, SCr was determined two or more times. Five (0.05%) admissions were excluded because vital status was unknown at discharge. The number of SCr determinations ranged from two to 92.
