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Risk factors and outcomes of acute kidney injury in South African critically ill adults: a prospective cohort study.
BMC Nephrology ( IF 2.2 ) Pub Date : 2019-12-10 , DOI: 10.1186/s12882-019-1620-7
Ryan E Aylward 1 , Elizabeth van der Merwe 1, 2 , Sisa Pazi 3 , Minette van Niekerk 1 , Jason Ensor 4, 5 , Debbie Baker 1, 2 , Robert J Freercks 4, 5
Affiliation  

BACKGROUND There is a marked paucity of data concerning AKI in Sub-Saharan Africa, where there is a substantial burden of trauma and HIV. METHODS Prospective data was collected on all patients admitted to a multi-disciplinary ICU in South Africa during 2017. Development of AKI (before or during ICU admission) was recorded and renal recovery 90 days after ICU discharge was determined. RESULTS Of 849 admissions, the mean age was 42.5 years and mean SAPS 3 score was 48.1. Comorbidities included hypertension (30.5%), HIV (32.6%), diabetes (13.3%), CKD (7.8%) and active tuberculosis (6.2%). The most common reason for admission was trauma (26%). AKI developed in 497 (58.5%). Male gender, illness severity, length of stay, vasopressor drugs and sepsis were independently associated with AKI. AKI was associated with a higher in-hospital mortality rate of 31.8% vs 7.23% in those without AKI. Age, active tuberculosis, higher SAPS 3 score, mechanical ventilation, vasopressor support and sepsis were associated with an increased adjusted odds ratio for death. HIV was not independently associated with AKI or hospital mortality. CKD developed in 14 of 110 (12.7%) patients with stage 3 AKI; none were dialysis-dependent. CONCLUSIONS In this large prospective multidisciplinary ICU cohort of younger patients, AKI was common, often associated with trauma in addition to traditional risk factors and was associated with good functional renal recovery at 90 days in most survivors. Although the HIV prevalence was high and associated with higher mortality, this was related to the severity of illness and not to HIV status per se.

中文翻译:

南非重症成年人的急性肾脏损伤的危险因素和结局:一项前瞻性队列研究。

背景技术在撒哈拉以南非洲,关于AKI的数据很少,那里有大量的创伤和HIV负担。方法收集了2017年南非多学科ICU入院的所有患者的前瞻性数据。记录了AKI的发展(在ICU入院前或入院期间),并确定了ICU出院90天后的肾脏恢复情况。结果849例入组患者的平均年龄为42.5岁,平均SAPS 3得分为48.1。合并症包括高血压(30.5%),HIV(32.6%),糖尿病(13.3%),CKD(7.8%)和活动性肺结核(6.2%)。入院的最常见原因是创伤(26%)。AKI开发于497(58.5%)。男性,疾病严重程度,住院时间,升压药和败血症与AKI独立相关。AKI的院内死亡率较高,为31.8%,而没有AKI的院内死亡率为7.23%。年龄,活动性肺结核,较高的SAPS 3评分,机械通气,升压药支持和败血症与死亡调整比值比增加有关。艾滋病毒并非与AKI或医院死亡率独立相关。110例3期AKI患者中有14例发生了CKD。没有一个是依赖透析的。结论在这个较大的前瞻性,多学科,ICU的年轻患者队列中,AKI很常见,除传统的危险因素外,通常还与创伤有关,并且在大多数幸存者中,其90天的肾功能恢复良好。尽管艾滋病毒的患病率很高,并且死亡率更高,但这与疾病的严重程度有关,而与艾滋病毒本身的状况无关。没有AKI的人占23%。年龄,活动性肺结核,较高的SAPS 3评分,机械通气,升压药支持和败血症与死亡调整比值比增加有关。艾滋病毒并非与AKI或医院死亡率独立相关。110例3期AKI患者中有14例发生了CKD。没有一个是依赖透析的。结论在这个较大的前瞻性,多学科,ICU的年轻患者队列中,AKI很常见,除传统的危险因素外,通常还与创伤有关,并且在大多数幸存者中,其90天的肾功能恢复良好。尽管艾滋病毒的患病率很高,并且死亡率更高,但这与疾病的严重程度有关,而与艾滋病毒本身的状况无关。没有AKI的人占23%。年龄,活动性肺结核,较高的SAPS 3评分,机械通气,升压药支持和败血症与死亡调整比值比增加有关。艾滋病毒并非与AKI或医院死亡率独立相关。110例3期AKI患者中有14例发生了CKD。没有一个是依赖透析的。结论在这个较大的前瞻性,多学科,ICU的年轻患者队列中,AKI很常见,除传统的危险因素外,通常还与创伤有关,并且在大多数幸存者中,其90天的肾功能恢复良好。尽管艾滋病毒的患病率很高,并且死亡率更高,但这与疾病的严重程度有关,而与艾滋病毒本身的状况无关。升压药支持和败血症与死亡的调整比值比增加相关。艾滋病毒并非与AKI或医院死亡率独立相关。110例3期AKI患者中有14例发生了CKD。没有一个是依赖透析的。结论在这个较大的前瞻性,多学科,ICU的年轻患者队列中,AKI很常见,除传统的危险因素外,通常还与创伤有关,并且在大多数幸存者中,其90天的肾功能恢复良好。尽管艾滋病毒的患病率很高,并且死亡率更高,但这与疾病的严重程度有关,而与艾滋病毒本身的状况无关。升压药支持和败血症与死亡的调整比值比增加相关。艾滋病毒并非与AKI或医院死亡率独立相关。110例3期AKI患者中有14例发生了CKD。没有一个是依赖透析的。结论在这个较大的前瞻性,多学科,ICU的年轻患者队列中,AKI很常见,除传统的危险因素外,通常还与创伤有关,并且在大多数幸存者中,其90天的肾功能恢复良好。尽管艾滋病毒的患病率很高,并且死亡率更高,但这与疾病的严重程度有关,而与艾滋病毒本身的状况无关。7%)患有3期AKI的患者;没有一个是依赖透析的。结论在这个较大的前瞻性,多学科,ICU的年轻患者队列中,AKI很常见,除传统的危险因素外,通常还与创伤有关,并且在大多数幸存者中,其90天的肾功能恢复良好。尽管艾滋病毒的患病率很高,并且死亡率更高,但这与疾病的严重程度有关,而与艾滋病毒本身的状况无关。7%)患有3期AKI的患者;没有一个是依赖透析的。结论在这个较大的前瞻性,多学科,ICU的年轻患者队列中,AKI很常见,除传统的危险因素外,通常还与创伤有关,并且在大多数幸存者中,其90天的肾功能恢复良好。尽管艾滋病毒的患病率很高,并且死亡率更高,但这与疾病的严重程度有关,而与艾滋病毒本身的状况无关。
更新日期:2019-12-10
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