心脏术后急性肾损伤患者肾脏替代治疗后肾脏预后的影响因素

目的 分析心脏术后出现急性肾损伤（acute kidney injury,AKI）并接受肾脏替代治疗（renal replacement therapy,RRT）患者肾脏预后的影响因素。 方法 接受心脏手术后出现AKI并接受RRT治疗的患者,记录患者临床资料,观察患者RRT后3个月是否脱离透析。脱离透析定义为肾功能恢复存活并脱离RRT连续2周。 结果 最终纳入185例患者,平均年龄（50.2±13.1）岁,男性占67.6%,术前肾小球滤过率估算值（eGFR）78.5（44.7-82.0）ml/（min·1.73 m2）。其中,95例患者脱离透析（51.4%）。多因素Logistic回归分析表明术前eGFR （HR=0.52,95% CI 0.46-0.77;P<0.05）、术中输注红细胞的量（HR=1.05,95% CI 1.01-1.26;P<0.05）、血管活性药物（HR=1.26,95% CI 1.09-1.56;P<0.05）是未脱离透析的独立危险因素。 结论 对于心脏术后需要RRT治疗的AKI患者,术前肾功能状态越差、术中红细胞输注量越高,RRT时需要使用血管活性药物的患者无法达到长期肾功能恢复的危险性越大。     

新疆石河子大学医学院第一附属医院ICU住院患者急性肾损伤患病现况调查及预后分析

目的：探讨ICU住院患者急性肾损伤（acute kidney injury,AKI）患病情况及预后情况,并对预后相关的危险因素进行分析。 方法：收集新疆石河子大学医学院第一附属医院2015年1月至2015年12月在ICU住院治疗患者资料,对于发生AKI的患者组成队列研究,回顾性分析ICU住院患者AKI的发生率、病因、病死率等流行病学情况,并采用Logistic回归分析预后的危险因素。结果：2015年1月至2015年12月ICU住院患者共655例,其中109例发生AKI,发病率为16.6%,男性患者87,女性患者22例,男女比例（3.95:1）。发生AKI起第7天观察时,63例存活,46例死亡,病死率42.2%;出院作为观察结局时,死亡患者54例,存活患者55例,病死率49.54%。发生AKI患者以住院期间最后一次肌酐检测值作为肾功预后判断指标,17.4%的患者肾功完全恢复,39.4%的患者肾功部分恢复,37.6%的患者肾功未恢复。多因素Logistics回归分析低血压（OR=6.338）、昏迷（OR=4.417）、APACHE-II评分（OR=1.453）是患者死亡预后的独立危险因素。肾脏预后相关的因素包括年龄、贫血、使用抗生素、出血。结论：AKI是ICU住院患者中越来越普遍并且或将成为灾难性的并发症。一旦发生AKI,患者病死率高、肾脏功能不易完全恢复。昏迷、低血压、APACHE-II评分是患者死亡的独立危险因素;年龄、贫血、使用抗生素、出血是患者肾脏功能预后的相关因素。     

心脏术后发生急性肾损伤的预后危险因素及防治

急性肾损伤（AKI）是心脏术后的严重并发症,是患者病死率增加的独立预后危险因素。本文将其发病率和病死率、发病机制、危险因素、预防及治疗做一综述。     

不停跳冠状动脉旁路移植术对糖尿病患者术后早期结果的影响

目的探讨糖尿病对冠状动脉旁路移植术的手术病死率和并发症发生率的影响作用.方法回顾分析1995年10月-2004年1月958例择期行冠状动脉旁路移植术的患者,其中191例并发糖尿病.糖尿病和无糖尿病患者按是否应用体外循环进一步分为四组,对四组患者术前、术后资料进行对比分析.结果糖尿病组应用体外循环患者手术病死率为5.6%,糖尿病组不停跳冠状动脉旁路移植术患者为2.1%.结论糖尿病是影响冠状动脉旁路移植术预后的危险因素,不停跳冠状动脉旁路移植术能显著减少糖尿病患者的手术病死率和并发症发生率.     

冠状动脉旁路移植术同期行瓣膜手术临床分析

目的总结在冠状动脉旁路移植术同期行心脏瓣膜手术的临床经验。方法30例患者在冠状动脉旁路移植术同期进行瓣膜手术,年龄40-76（62．9±10．4）岁。其中缺血性瓣膜病变22例,风湿性瓣膜病变8例。术前冠状动脉造影诊断26例,术中发现冠脉严重病变4例。全组共移植血管133支（平均4．43支）。同期行主动脉瓣置换术3例、二尖瓣置换术12例、二尖瓣成形术8例、双瓣膜手术7例。结果术后住院死亡1例（3．3％）,死于严重低心排血量。术后心功能Ⅰ级22例、Ⅱ级7例,均较术前明显改善。结论同期行冠状动脉旁路移植术和瓣膜手术安全、有效。冠心病与心脏瓣膜病同时存在明显加重了心肌损害,完善纠治瓣膜病变、充分心肌再血管化和严格的术中心肌保护是手术成功的关键。     

心脏瓣膜手术同期冠状动脉旁路移植术的临床探讨

目的 探讨心脏瓣膜手术同期冠状动脉旁路移植术的治疗效果.方法 回顾性分析2010年1月至2013年8月新疆医科大学第一附属医院心脏外科心脏瓣膜手术同期行冠状动脉旁路移植术45例患者的临床病例资料,对其进行整理统计分析,评价治疗效果.结果 患者术后左心室舒张末径较前明显减小,差异均有统计学意义（P＜0.01）;左心室射血分数较术前明显升高,差异均有统计学意义（P＜0.05）.术后早期（住院期间）死亡3例,其中2例发生低心排综合征、1例室颤均抢救无效死亡.通过电话及门诊复查,随访3～24个月,2例失访,失访率4.44％,无一例死亡.结论 心脏瓣膜手术同期行冠状动脉旁路移植术的治疗效果满意.充分的术前准备、合理的手术方案、有效的心肌保护措施、熟练的手术技术及术后的重症监护治疗是手术成功的关键.     

体外循环心脏手术后急性呼吸窘迫综合征的临床特点及预后分析

目的:分析体外循环(CPB)心脏术后急性呼吸窘迫综合征(ARDS)患者的临床特点,预后情况及危险因素。方法:回顾性分析2005年1月至2015年12月,于首都医科大学附属北京安贞医院心脏外科行体外循环心脏手术后发生ARDS的144例患者。记录患者围术期相关资料和预后情况,二元Logistic回归分析影响预后的危险因素。结果:CPB心脏手术后ARDS患者144例平均年龄55.3岁,其中男性98例,占68.1%。CPB术后ARDS患者病死率27.8%(40/144)。CPB心脏手术后发生ARDS的主要手术类型是大血管手术,占28.5%,其次是CABG联合瓣膜手术占18.8%,多瓣膜手术占17.3%。不同手术类型对于ARDS患者的气管插管时间和住ICU时间,差异无统计学意义。二元Logistic回归分析示低BMI、术后应用ECMO和CRRT是患者院内死亡的危险因素(P均0.05)。结论:CPB心脏术后ARDS患者病死率高,低BMI、术后应用ECMO或CRRT的ARDS患者院内死亡风险更高。     

ICU住院患者急性肾损伤患病现况调查及预后分析

目的:探讨ICU住院患者急性肾损伤(AKI)的患病及预后情况,并对预后相关危险因素进行分析。方法:回顾性分析655例ICU住院患者AKI的发生率、病因、病死率等流行病学情况,并采用Logistic回归分析影响预后的危险因素。结果:655例患者中发生AKI 109例(男87,女22)(16.6%),男女比例(3.95:1)。发生AKI第7天,46例死亡,病死率42.2%;发生AKI患者出院前肾功能完全恢复19例(17.4%),肾功能部分恢复43例(39.4%),肾功能未恢复41例(37.6%)。多因素Logistics回归分析低血压(OR=6.338)、昏迷(OR=4.417)、APACHEⅡ评分(OR=1.453)是患者死亡的独立危险因素。与肾功能预后相关的因素包括年龄、贫血、使用抗生素、出血。结论:AKI是ICU住院患者中越来越普遍且严重的并发症。一旦发生AKI,患者病死率高、肾功能难以完全恢复。昏迷、低血压、APACHEⅡ评分是患者死亡的独立危险因素;年龄、贫血、使用抗生素、出血是患者肾脏功能预后的相关因素。     

肝癌术后重症患者围手术期低血压的危险因素分析

目的 探讨肝癌术后重症患者围手术期低血压相关危险因素及其对预后的影响。方法 回顾性分析2014年1月—2019年12月于北京大学人民医院因原发性肝癌或转移性肝癌行手术治疗后转入ICU的422例患者的临床资料。将术中或术后需要持续泵入血管活性药物（去甲肾上腺素、多巴胺、苯肾上腺素、肾上腺素）维持血压者纳入低血压组（n=107）,不需泵入血管活性药物维持血压者纳入非低血压组（n=315）。收集所有患者性别、年龄、BMI、肝脏手术史、合并症、肝脏基础疾病、术前实验室检查、外科和麻醉情况等临床资料。比较两组患者预后相关指标（院内病死率，ICU住院时间、总住院时间、机械通气时间、急性肾损伤、低氧血症、肺部感染、心肌损伤）。符合正态分布的计量资料两组间比较采用独立样本t检验；不符合正态分布和方差齐的计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ²检验。将P<0.1的临床指标纳入二元logistic多因素回归分析低血压危险因素。结果 肝癌术后重症患者总体病死率为1.9%,低血压组病死率为3.7%,非低血压病死率为1.3%。相较于非低血压组...     

同期行冠状动脉旁路移植术与心脏瓣膜手术的临床分析

目的探讨同期施行冠状动脉旁路移植术与心脏瓣膜手术益处的临床分析。方法回顾性分析52例经历冠状动脉旁路移植术与心脏瓣膜手术患者,其中两者同期施行有24例为同期组,非同期施行有28例为非同期组,比较两组术后并发症及远期随访预后的临床资料。结果与非同期组相比,同期组在机械辅助通气时间、ICU停留时间、恶性心律失常发生率、低心排出量综合征发生率明显减低（P〈0.05）;而远期随访中永久性起搏器植入率、瓣周漏及死亡率也明显降低（P〈0.05）。结论同期施行冠状动脉旁路移植术与心脏瓣膜手术对于患者有明显的近期及远期临床益处。     

Outcomes of cardiac surgery in patients > or = 80 years: results from the National Cardiovascular Network

OBJECTIVES: The purpose of this study was to evaluate characteristics and outcomes of patients age > or =80 undergoing cardiac surgery. BACKGROUND: Prior single-institution series have found high mortality rates in octogenarians after cardiac surgery. However, the major preoperative risk factors in this age group have not been identified. In addition, the additive risks in the elderly of valve replacement surgery at the time of bypass are unknown. METHODS: We report in-hospital morbidity and mortality in 67,764 patients (4,743 octogenarians) undergoing cardiac surgery at 22 centers in the National Cardiovascular Network. We examine the predictors of in-hospital mortality in octogenarians compared with those predictors in younger patients. RESULTS: Octogenarians undergoing cardiac surgery had fewer comorbid illnesses but higher disease severity and surgical urgency than younger patients. Octogenarians had significantly higher in-hospital mortality after cardiac surgery than younger patients: coronary artery bypass grafting (CABG) only (8.1% vs. 3.0%), CABG/aortic valve (10.1% vs. 7.9%), CABG/mitral valve (19.6% vs. 12.2%). In addition, they had twice the incidence of postoperative stroke and renal failure. The preoperative clinical factors predicting CABG mortality in the very elderly were quite similar to those for younger patients with age, emergency surgery and prior CABG being the powerful predictors of outcome in both age categories. Of note, elderly patients without significant comorbidity had in-hospital mortality rates of 4.2% after CABG, 7% after CABG with aortic valve replacement (CABG/AVR), and 18.2% after CABG with mitral valve replacement (CABG/MVR). CONCLUSIONS: Risks for octogenarians undergoing cardiac surgery are less than previously reported, especially for CABG only or CABG/AVR. In selected octogenarians without significant comorbidity, mortality approaches that seen in younger patients.     

Incidence and clinical outcomes of acute kidney injury requiring renal replacement therapy in Japan

No population-based studies have described the prevalence of acute kidney injury (AKI) treated with renal replacement therapy (RRT) in Japan. This study prospectively examined the incidence of AKI requiring RRT by surveying 16 hospitals in Shizuoka prefecture from January to October 2006. The subjects comprised 242 patients treated with RRT during the observation period. The estimated incidence of AKI requiring RRT was 13.3 cases/100,000 persons/year in this area. Major contributing factors for AKI were sepsis (34%), cardiac shock (23%), and major surgery (12%). The in-hospital mortality rate was 47.1%, paralleling the increased number of insufficient organs. Oliguria was a risk factor for in-hospital mortality. These findings suggest that the incidence of AKI treated with RRT in Japan is comparable to those in Western countries, and the prognosis of AKI patients requiring RRT is also poor in Japanese patients.     

A型主动脉夹层术后严重高胆红素血症并发急性肾损伤患者的预后及危险因素

目的 探讨A型主动脉夹层术后严重高胆红素血症并发急性肾损伤（AKI）患者的预后及危险因素。 方法 回顾性筛选西京医院2015年1月~2018年12月行A型主动脉夹层手术治疗的患者,术后同时发生严重高胆红素血症和AKI的患者被纳入研究。研究终点包括住院死亡和长期死亡。采用单因素和多因素分析住院死亡相关的危险因素,使用Kaplan-Meier生存曲线来评估患者的长期生存率以及AKI的不同分期对长期生存的影响。 结果 221例患者被纳入研究,50例患者接受持续性肾脏替代治疗（CRRT）,82例患者住院死亡。1年、2年和3年累积病死率分别是39.0%、40.2%和41.1%。多因素Logistic 回归分析显示,A型主动脉夹层术后严重高胆红素血症并发AKI患者死亡的独立危险因素为:术后第1天平均动脉压（OR0.967,95%CI 0.935-1.000;P<0.01）、术后机械通气时长（OR 1.189,95%CI 1.003-1.410;P<0.05）、术后总输血量（OR 1.019,95%CI 1.003-1.036;P<0.05）以及AKI 3期（OR 12.639,95%CI5.409-34.388;P<0.01）。 结论 A型主动脉夹层术后严重高胆红素血症并发AKI患者的住院病死率以及长期病死率较高。AKI 3期,术后较低的平均动脉压,延长的术后机械通气以及增加的术后输血量是患者住院死亡的危险因素。因此,临床医生应该更密切地监测具有这些高风险的患者。     

The prognosis and risk factors for acute kidney injury in high-risk patients after surgery for type A aortic dissection in the ICU

BackgroundAcute kidney injury (AKI) is a major complication of cardiac surgery, with high rates of morbidity and mortality. The aim of this study was to identify risk factors for the incidence and prognosis of AKI in high-risk patients before and after surgery for acute type A aortic dissection (TAAD) in the intensive care unit (ICU).MethodsWe performed a retrospective cohort study from April 2018 to April 2019. The primary end points of this study were morbidity due to AKI and risk factors for incidence, and the secondary end points were mortality at 28 days and risk factors for death.ResultsWe enrolled 60 patients, 52 (86.67%) patients developed postoperative AKI, 28 (53.84%) patients died. Preoperative lactic acid level (P=0.022) and cardiopulmonary bypass (CPB) duration (P=0.009) were identified as independent risk factors for postoperative AKI. The 28-day mortality for postoperative patients with TAAD was 46.67%, 53.84% for those with TAAD and AKI, 67.5% for those who required continue renal replacement therapy (CRRT). The risk factors for 28-day mortality due to postoperative AKI for patients requiring CRRT were CPB duration (P=0.019) and norepinephrine dose upon diagnosis of AKI (P=0.037).ConclusionsMorbidity due to AKI in postoperative patients with TAAD was 86.67%, and preoperative lactic acid level and CPB duration were independent risk factors. The 28-day mortality of postoperative patients with TAAD was 46.67%, 53.84% for those with TAAD and AKI, and 67.5% for those requiring CRRT. CPB duration and norepinephrine dose upon diagnosis of AKI may influence patients’ short-term prognosis.     

Predictors and in-hospital outcomes of preoperative acute kidney injury in patients with type A acute aortic dissection

Background Acute kidney injury (AKI) is common after surgery for acute aortic dissection (AAD) and increases in-hospital and long-term mortality. However, few data exist on the clinical and prognostic relevance of early preoperative AKI in patients with type A AAD. We aimed to determine the incidence and predictors of preoperative AKI and the impact of AKI on in-hospital outcomes in patients with type A AAD. Methods From May 2009 to June 2014, we retrospectively enrolled 178 patients admitted to our hospital within 48 h from symptom onset and receiving open surgery for type A AAD. The patients were divided into no AKI and AKI groups and staged with AKI severity according to the KDIGO criteria before surgery. Results AKI occurred in 41 patients (23.0%). The incidence of in-hospital complications was significantly higher in patients with preoperative AKI compared to no AKI (41.5% vs. 9.5%, P < 0.001), including renal infarction (7.3% vs. 0, P = 0.012), and it increased with AKI severity (P_trend < 0.001). Patients with AKI had higher in-hospital mortality compared with patients without AKI, although no significant difference was found (14.6% vs. 5.1%, P = 0.079). Multivariate analysis indicated that male gender, diastolic blood pressure on admission and bilateral renal artery involvement were independent predictors of preoperative AKI in patients with type A AAD. Conclusions Early AKI before surgery was common in patients with type A AAD, and was associated with increased in-hospital complications. Male gender, diastolic blood pressure on admission and bilateral renal artery involvement were major predictors for preoperative AKI.     

Percutaneous coronary intervention with vs without on-site cardiac surgery backup: a systematic review and meta-analysis

Although the popularity of performing percutaneous coronary intervention (PCI) in centres without on-site cardiac surgery backup is increasing, the safety of this practice is unknown. Our goal was to perform a systematic review and meta-analysis of PCI with and without on-site cardiac surgery backup. We identified studies using computerized literature searches through July 2009. Main outcomes of interest included in-hospital mortality and early coronary artery bypass grafting (CABG). Analyses were stratified by procedure indication (primary PCI and nonprimary PCI). Pooled estimates were obtained using random-effects models. We identified 9 primary PCI studies (106,089 patients) and 7 nonprimary studies (910,422 patients) comparing centres with and without on-site cardiac surgery. For primary PCI, centres without on-site surgery had no significantly increased risk of in-hospital mortality (odds ratio [OR] 0.93; 95% confidence interval [CI], 0.83-1.05) or early CABG (OR 0.87; 95% CI, 0.68-1.11) compared with centres with on-site surgery. For nonprimary PCI, no increased risk of in-hospital mortality (OR 1.03; 95% CI, 0.64-1.66) and early CABG (OR 1.38; 95% CI, 0.65-2.95) was observed in centres without backup. However, significant heterogeneity existed in estimates of nonprimary PCI studies, suggesting substantial variation in outcomes of nonprimary PCI across centres without on-site cardiac surgery. We demonstrated that rates of in-hospital mortality and early CABG were similar at PCI centres with and without on-site cardiac surgery backup. However, variations in outcomes suggest that assurance of optimal outcomes at each PCI centre without on-site surgery is needed.     

RNA-Seq identifies condition-specific biological signatures of ischemia-reperfusion injury in the human kidney

Acute kidney injury (AKI) is a life-threatening complication of rhabdomyolysis (RM). The aim of the present study was to assess patients at high risk for the occurrence of severe AKI defined as stage II or III of KDIGO classification and in-hospital mortality of AKI following RM. We performed a retrospective study of patients with creatine kinase levels > 1000 U/L, who were admitted to the West China Hospital of Sichuan University between January 2011 and March 2019. The sociodemographic, clinical and laboratory data of these patients were obtained from an electronic medical records database, and univariate and multivariate regression analyses were subsequently conducted. For the 329 patients included in our study, the incidence of AKI was 61.4% and the proportion of stage I, stage II, stage III were 18.8, 14.9 and 66.3%, respectively. The overall mortality rate was 19.8%; furthermore, patients with AKI tended to have higher mortality rates than those without AKI (24.8% vs. 11.8%; P < 0.01). The clinical conditions most frequently associated with RM were trauma (28.3%), sepsis (14.6%), bee sting (12.8%), thoracic and abdominal surgery (11.2%) and exercise (7.0%). Furthermore, patients with RM resulting from sepsis, bee sting and acute alcoholism were more susceptible to severe AKI. The risk factors for the occurrence of stage II-III AKI among RM patients included hypertension (OR = 2.702), high levels of white blood cell count (OR = 1.054), increased triglycerides (OR = 1.260), low level of high-density lipoprotein cholesterol (OR = 0.318), elevated serum phosphorus (OR = 5.727), 500010,000 U/L (OR = 8.093). Age ≥ 60 years (OR = 2.946), sepsis (OR = 3.206) and elevated prothrombin time (OR = 1.079) were independent risk factors for in-hospital mortality in RM patients with AKI. AKI is independently associated with mortality in patients with RM, and several risk factors were found to be associated with the occurrence of severe AKI and in-hospital mortality. These findings suggest that, to improve the quality of medical care, the early prevention of AKI should focus on high-risk patients and more effective management.     

Preoperative Statin Therapy Decreases Risk of Postoperative Renal Insufficiency

Introduction: Although current guidelines recommend withholding statins in perioperative patients, little information is available on whether perioperative statin use increases risk for postoperative renal failure. Aims: We examined the relation between preoperative statin therapy and postoperative risk for renal insufficiency in patients undergoing cardiac surgery. Methods: Retrospective cohort review from the Texas Heart Institute research database was performed. Patients were divided into two groups: those who received preoperative statins and those who did not. Primary outcome was the development of postoperative renal insufficiency (requiring dialysis or not). Outcomes were assessed in the entire cohort and in subgroups undergoing isolated coronary artery bypass grafting (CABG), isolated valve surgery, or combined CABG and valve surgery. Results: Of 3001 patients, 56% received preoperative statins. In multivariate logistic regression analysis, preoperative statins were associated with significant reductions in risk for postoperative renal insufficiency in the entire cohort (odds ratio [OR]= 0.60, 95% confidence interval [CI] 0.38–0.95) and in patients undergoing isolated CABG (OR = 0.34, 95% CI 0.17–0.68). In patients undergoing isolated valve surgery (OR = 1.35, 95% CI 0.61–2.96) or combined CABG and valve surgery (OR = 1.39, 95% CI 0.48–3.99), preoperative statins were not associated with decreased incidence of postoperative renal insufficiency. Age >65 years, preoperative renal insufficiency, history of congestive heart failure, preoperative intra‐aortic balloon pump insertion, and total cardiopulmonary bypass time >80 min were also independent predictors associated with increased risk for postoperative renal insufficiency. Conclusions: Preoperative statin therapy was associated with decreased incidence of postoperative renal insufficiency in patients undergoing cardiac surgeries, particularly in patients undergoing isolated CABG.     

中国冠状动脉旁路移植术注册登记研究

目的 了解目前我国冠状动脉旁路移植术(CABG)的一般情况及整体水平.方法 2006年在阜外心血管病医院牵头下,联合中国内地32家心脏外科中心进行CABG的回顾性注册登记研究.研究采用填写登记表格的方式,收集行CABG患者的术前、术中及术后相关信息,并对这些信息进行统计学分析.结果 中国内地32家心脏外科中心2004年1月至2005年12月共行9247例CABG.患者年龄(62.1±9.1)岁,女性比例为21.5%,冠状动脉3支病变比例为76.7%,左主干病变比例为25.8%.总体表观院内病死率为3.3%.单纯CABG表观院内病死率为2.2%.结论 中国内地CABG院内病死率及重要手术事件的发生率均较低.需要研究并建立适合我国人群的CABG死亡风险评估系统.     

Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults

Background and objectives

Comprehensive epidemiologic data on AKI are particularly lacking in Asian countries. This study sought to assess the epidemiology and clinical correlates of AKI among hospitalized adults in China.

Design, setting, participants, & measurements

This was a multicenter retrospective cohort study of 659,945 hospitalized adults from a wide range of clinical settings in nine regional central hospitals across China in 2013. AKI was defined and staged according to Kidney Disease Improving Global Outcomes criteria. The incidence of AKI in the cohort was estimated using a novel two-step approach with adjustment for the frequency of serum creatinine tests and other potential confounders. Risk factor profiles for hospital-acquired (HA) and community-acquired (CA) AKI were examined. The in-hospital outcomes of AKI, including mortality, renal recovery, length of stay, and daily cost, were assessed.

Results

The incidence of CA-AKI and HA-AKI was 2.5% and 9.1%, respectively, giving rise to an overall incidence of 11.6%. Although the risk profiles for CA-AKI and HA-AKI differed, preexisting CKD was a major risk factor for both, contributing to 20% of risk in CA-AKI and 12% of risk in HA-AKI. About 40% of AKI cases were possibly drug-related and 16% may have been induced by Chinese traditional medicines or remedies. The in-hospital mortality of AKI was 8.8%. The risk of in-hospital death was higher among patients with more severe AKI. Preexisting CKD and need for intensive care unit admission were associated with higher death risk in patients at any stage of AKI. Transiency of AKI did not modify the risk of in-hospital death. AKI was associated with longer length of stay and higher daily costs, even after adjustment for confounders.

Conclusion

AKI is common in hospitalized adults in China and is associated with significantly higher in-hospital mortality and resource utilization.