印度北部一家三级医院社区获得性急性肾损伤与医院获得性急性肾损伤的比较研究。

IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Annals of African Medicine Pub Date : 2024-07-01 Epub Date: 2024-07-20 DOI:10.4103/aam.aam_110_23

Munna Lal Patel, Rekha Sachan, Rahul Kumar

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引用次数: 0

摘要

背景：在这项观察性研究中，我们比较了社区获得性急性肾损伤（CAAKI）患者与医院获得性急性肾损伤（HAAKI）患者的临床特征、病因和住院结果：这是一项前瞻性研究，研究对象是一家三级医院中被诊断为急性肾损伤（AKI）的 18 岁或以上成年人，历时 17 个月。178例（77.4%）患者来自内科，25例（10.7%）来自外科，27例（11.7%）来自产科。观察到的 AKI 发生率为 15/1000。约 58.2% 的患者出现 CAAKI，96 例（43.7%）出现 HAAKI。在230名患者中，170名（73.9%）为男性，60名（26.1%）为女性。在内科病例中，败血症是导致急性肾损伤最常见的病因（52.1%）。尿毒症、恙虫病和肺炎是最常见的急性肾损伤病因。60%的急性肾脏病属于肾病改善全球结果的第一或第二阶段，40%属于第三阶段。56.5%的患者出现少尿，34.7%的患者出现高钾血症，6.1%的患者出现液体超负荷，22.6%的患者出现代谢性酸中毒。大多数患者（52.1%）在入院时有多器官受累。约 116 名患者（50.4%）肺部受伤，需要进行机械通气，95 名患者（41.3%）使用肌注。死亡率为 19.5%。贫血、使用血管加压药和需要重症监护支持是预测死亡率的独立因素：结论：AKI 在住院患者中很常见，会导致严重的院内死亡率。AKI 主要是 CAAKI，其次是 HAAKI。许多原因是可以预防的。早期液体复苏、有效的抗生素、适当的解毒剂，以及及时将已确诊的 AKI 患者转诊至有透析设施的中心，可改善 AKI 的预后。

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A Comparative Study of Community-acquired Acute Kidney Injury and Hospital-acquired Acute Kidney Injury from a Tertiary Care Hospital in North India.

Background: In this observational study, clinical characteristics, etiologies, and outcomes of patients admitted to the hospital with community-acquired acute kidney injury (CAAKI) have been compared in contrast to those who hospital-acquired Acute Kidney Injury (HAAKI).

Methods: This was a prospective study of adults aged 18 years or above diagnosed with acute kidney injury (AKI) over a period of 17 months at a tertiary care hospital.

Results: 230 patients had AKI with the mean age of the study population being 45.33 ± 12.68 years. 178 (77.4%) patients were enrolled from medical unit, 25 (10.7%) from surgical unit, and 27 (11.7%) from obstetrical unit. The observed incidence of AKI was 15/1000 admissions. About 58.2% had CAAKI and 96 (43.7%) had HAAKI. Out of 230 patients, 170 (73.9%) patients were male and 60 (26.1%) were female. Sepsis was the most common (52.1%) etiology of AKI among the medical cases. Urosepsis, scrub typhus, and pneumonia were the most common causes of AKI. Sixty percent of AKI was Kidney Disease Improving Global Outcomes Stage 1 or 2 and 40% was in Stage 3. Oliguria was seen in 56.5%, hyperkalemia in 34.7%, fluid overload in 6.1%, and metabolic acidosis in 22.6%. The majority of patients had multiple organ involvement (52.1%) at the time of enrollment. About 116 (50.4%) had lung injury requiring mechanical ventilation and 95 (41.3%) were on inotropes. Mortality occurred in 19.5%. Anemia, the use of vasopressor drugs, and the need for intensive care support were independent predictive factors for mortality.

Conclusion: AKI was common in hospitalized patients and leads to significant inhospital mortality. AKI is largely a CAAKI, and the lesser extent is due to HAAKI. Many causes are potentially preventable. Early fluid resuscitation, effective antibiotics, appropriate antidotes, and timely referral of established AKI patients to centers with dialysis facilities can improve AKI outcomes.

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Annals of African Medicine MEDICINE, GENERAL & INTERNAL-

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期刊介绍： The Annals of African Medicine is published by the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria and the Annals of African Medicine Society. The Journal is intended to serve as a medium for the publication of research findings in the broad field of Medicine in Africa and other developing countries, and elsewhere which have relevance to Africa. It will serve as a source of information on the state of the art of Medicine in Africa, for continuing education for doctors in Africa and other developing countries, and also for the publication of meetings and conferences. The journal will publish articles I any field of Medicine and other fields which have relevance or implications for Medicine.