ACUTE KIDNEY INJURY FOLLOWING ACUTE CHOLANGITIS: A RISK MULTIPLIER FOR ADVERSE OUTCOMES AND HEALTHCARE UTILIZATION.

IF 2.7 3区医学 Q2 CRITICAL CARE MEDICINE SHOCK Pub Date : 2025-02-01 Epub Date: 2024-08-16 DOI:10.1097/SHK.0000000000002462

Lili Tang, Weiwei Wan, Jie Zhang, Hongtao Zhang, Yuhao Wang, Xiaoyue Li

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Abstract

Abstract: Background: Acute kidney injury (AKI) is a common, fatal complication of acute cholangitis (AC). The link between AC and AKI is poorly understood. Aims: To delineate the incidence trends, clinical outcomes and healthcare utilization of inpatients with AKI following AC and to explore the risk factors for AKI following AC. Methods: This population-based retrospective study used the National Inpatient Sample database from 2010 to 2018 to compare the demographics, complications, in-hospital mortality and healthcare utilization between AC patients with and without AKI. Predictors of AKI and the prognostic impact of AKI on in-hospital outcomes were defined using multivariate logistic regression. Results: The overall incidence of AKI was 24.06% among AC patients. Its trend generally increased annually. AKI was associated with more complications, greater invasive therapy requirements, longer hospital stays, costlier total hospital charges, and higher in-hospital mortality. The risk factors for AKI following AC were advanced age, Black race, multiple comorbidities, large hospitals, teaching hospitals, urban hospitals, hospitals in the southern and western United States, choledocholithiasis/cholelithiasis, surgery, percutaneous transhepatic biliary drainage, deficiency anemia, congestive heart failure, coagulopathy, diabetes, hypertension, chronic liver disease, obesity, chronic kidney disease excluding end-stage renal disease, weight loss, acute pancreatitis, and severe sepsis. Female sex, private insurance, elective admission, and endoscopic retrograde cholangiopancreatography were protective factors against AKI in AC patients. Conclusion: AKI often follows AC and is strongly associated with poor prognosis and increased healthcare utilization. Healthcare professionals should make more efforts to identify patients with AC at risk of AKI and start management promptly to limit adverse outcomes.

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急性胆管炎后的急性肾损伤：不良后果和医疗保健使用的风险乘数。

背景：急性肾损伤（AKI）是急性胆管炎（AC）常见的致命并发症。目的：了解急性胆管炎并发急性肾损伤住院患者的发病趋势、临床结局和医疗使用情况，并探讨急性胆管炎并发急性肾损伤的风险因素：这项以人群为基础的回顾性研究使用了 2010 年至 2018 年的全国住院患者抽样数据库，比较了有和没有 AKI 的 AC 患者的人口统计学、并发症、院内死亡率和医疗使用情况。采用多变量逻辑回归法确定了AKI的预测因素以及AKI对院内预后的影响：结果：在 AC 患者中，AKI 的总发生率为 24.06%。其趋势呈逐年上升趋势。AKI 与更多的并发症、更多的侵入性治疗需求、更长的住院时间、更贵的住院总费用和更高的院内死亡率相关。高龄、黑人、多种并发症、大型医院、教学医院、城市医院、美国南部和西部医院、胆总管结石/胆囊结石、外科手术、经皮经肝胆道引流术、缺血性贫血、充血性心力衰竭、凝血功能障碍、糖尿病、高血压、慢性肝病、肥胖、慢性肾病（不包括终末期肾病）、体重减轻、急性胰腺炎和严重败血症是急性肾功能衰竭的危险因素。女性、私人保险、择期入院和内镜逆行胰胆管造影是急性胰腺炎患者发生 AKI 的保护因素：结论：急性胰腺炎患者通常会出现 AKI，这与预后不良和医疗费用增加密切相关。医护人员应更加努力地识别有发生 AKI 风险的 AC 患者，并及时开始治疗，以减少不良后果。

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来源期刊

SHOCK 医学-外科

CiteScore

6.20

自引率

3.20%

发文量

199

审稿时长

1 months

期刊介绍： SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.