The Incidence And Risk Factors Associated With Prognosis Of Hospital-acquired Acute Kidney Injury In Hospitalized Patients

ObjectiveTo clarify the incidencee basic characteristics,prognosis and related risk factors of hospital-acquired acute kidney injury(HA-AKI),and providing reliable evidence for epidemiology status of acute kidney injury and clinical prevention and treatment strategies.MethodUsing the hospital electronic medical record system database and the serum creatinine test database to find all hospitalized patients in Nan fang Hospital from January 1,2013 to December 31,2013,excluding those with age<15 years or age>100 years,those the length of stay less than 48 hours,and those the clinical information were not completed,and those in hospitalization with Scr tests less than two times in a 7-day window within 30 days of admission,and those with CKD4-5,and those recieved maintenance dialysis,and those with renal transplant.Finally,a total of 12,519 hospitalizations in the final analysis,according to the KIDGO guidelines of 2012 redefined the AKI,Finally there were total 1253 AKI patients,in which the HA-AKI group were 847,the CA-AKI group were 406,and the Non-AKI group were 11266.The trained nephrologists through the hospital electronic medical record system to obtain all patients’ clinical data and filled in the registration form case,including the demographic data,the underlying disease,the diagnosis at admission,the discharge diagnosis,the length of stay,the hospital cost,the laboratory and imaging laboratory data,the treatment programs,the complications and the discharge conditions.To calculating the incidence of HA-AKI and analyses the prognosis with the related risk factors.Statistical:Normal continuous variables were displayed as mean ± standard deviation and compared using student,s t-test,otherwise vwere displayed as median(Interquartile)and compared using nonparametric rank sum test.Categorical variables were expressed as constituent ratio or percentage and compared with chi-square test.Binomial logistic regression analysis was used to establish the prediction models with AKI and the prognosis,P<0.05 in the univariate analysis were candidated for the multivariable logistic analysis.The odds ratio(OR)and confidence interval(Cl)of 95%were expressed,P<0.05 was considered statistically significant,statistical analysis was performed with the SPSS software(version 20.0 for Windows).ResultsThere were total 12133 admissions during the study period,the Non-AKI group were 11266,the HA-AKI group were 847,so the morbidity of HA-AKI was 8.7%.the male and female patients were 536 and 311,respectively,the ratio of male to female was 1.72:1.The average of age in the HA-AKI group was(55.2±17.3)years old,in which the percentage of patients with age more than 60 years old was 41%higher than the Non-AKI group(p<0.001).The average of the length of stay was(23.5±19.5)days and the average daily costs was(3980±3172)yuan,that were all higher than the Non-AKI group(p<0.001).Multivariate logistic regression analysis showed that age(OR=1.006,95%CI=1.002-1.011,p＝0.009),heart failure(OR=3.316,95%CI＝2.708-4.060,p<0.001),Pneumonia(OR=2.040,95%CI=1.737-2.395,p<0.001),stroke(OR=1.747,95%CI=1.385-2.204,p<0.001),gastrointestinalbleeding(OR=1.443,95%CI=1.050-1.981,p＝0.024),shock(OR=7.360,95%CI＝5.591-9.688,p<0.001),cardiac-surgery(OR=7.291,95%CI＝5.103-10.415,p<0.001),sepsis(OR=2.295,95%CI=1.576-3.342,p<0.001),preexisting CKD(OR=2.352,95%CI=1.580-3.501,p<0.001),urinary tract obstruction(OR＝2.073,95%CI=1.517-2.832,p<0.001),and the intensive care(OR=2.092,95%CI＝1.736-2.522,p<0.001)were the risk factors for HA-AKI patients.There were total 91 patients died in the HA-AKI group,so the mortality of HA-AKI was 10.7%.Multivariate logistic regression analysis showed that the stage of AKI(OR=2.179,95%CI=1.601-2.966,p<0.001),extra-renal organs failure(OR=2.435,95%CI=1.908-3.107,p=0.001),SIRS(OR=2.069,95%CI=1.104－3.878,p＝0.023),acute heart failure(OR＝2.828,95%CI=1.508-5.303,p=0.001),respiratory failure(OR=7.176,95%CI=3.806-13.530,p<0.001),nervous system dysfunction(OR=2.616,95%CI＝1.479-4.627,p=0.001)and blood and digestive dysfunction(OR=2.434,95%CI＝1.328-4.426,p=0.004)were the risk factors of death for HA-AKI patients.Multivariate logistic regression analysis showed that the risk factors for renal function were extra-renal organs failure(OR=1.282,95%CI＝1.123-1.463,p<0.001),renal-replacement-therapy(OR=6.632,95%CI=2.574-17.088,P<0.001)and respiratory failure(OR＝4.021,95%CI＝2.082-7.764,p<0.001),in which extra-renal organs failure were the common risk factors for death and renal function for HA-AKI patients.ConclusionAKI is still common in hospitalized patients,the incidence and mortality of HA-AKI are still high.The older are at high risk of HA-AKI.age.heart failure、pneumonia、stroke、shock、cardiac surgery、gastrointestinal bleeding、sepsis、preexisting CKD and urinary tract obstruction were the risk factors for patients to developed HA-AKI.The stage of AKI、extra-renal organs failure、SIRS、heart failure、respiratory failure、nervous system dysfunction、blood and digestive dysfunction were the risk factors of HA-AKI patients for prognosis.extra-renal organs failure and renal replacement therapy were the risk factors for renal loss of HA-AKI patients.