未经证实:老年患者的急性肾损伤(AKI)与较高的住院死亡率相关。然而,AKI与围插管并发症之间的关系尚不清楚.
未经评估:本次回顾,观察,多中心队列研究纳入了2008年至2020年在解放军总医院四个医疗中心接受有创机械通气(MV)的3271例连续老年患者(≥75岁)。根据2012KDIGO标准,在MV的前48小时内,血清肌酐绝对增加≥26.5µmol/L,诊断为AKI。我们记录了随后的住院并发症,包括消化道出血,新出现的电解质失衡,严重的低氧血症,低蛋白血症,心血管不稳定和全因90天死亡率。
UNASSIGNED:最终评估共纳入1292例患者,29.1%的人出现AKI(阶段1:31.4%,第二阶段:35.1%,第三阶段:33.5%)。多元回归分析显示,更晚期的AKI增加了MAP<65mmHg的风险(阶段1:OR=1.833,P=0.002;阶段2:OR=4.653,P<0.001;阶段3:OR=4.834,P<0.001)和SBP<90mmHg(阶段1:OR=1.644,P=0.014;阶段2:OR=3.701,P<0.001;阶段3:OR=5.750,新需要或需要增加血管加压药的剂量(第1阶段:OR=1.523,P=0.014;第2阶段:OR=3.250,P<0.001;第3阶段:OR=12.132,P<0.001),消化道出血(阶段1:OR=1.102,P=0.669;阶段2:OR=1.471,P=0.060;阶段3:OR=2.377,P<0.001),重度缺氧(1期:OR=1.213,P=0.399;2期:OR=1.449,P=0.077;3期:OR=2.214,P<0.001)和全因90天死亡率(1期:OR=0.935;P=41;2期:OR=1.888;P=0.001;3期:OR=12.584;P<0.001).
UNASSIGNED:我们的研究表明,老年患者在MV的前48小时内出现AKI与插管后并发症和90天死亡率的高风险相关。此外,严重AKI患者出现并发症的风险更大.
UNASSIGNED: Acute kidney injury (AKI) in elderly patients is associated with higher hospital mortality. However, the relationship between AKI and peri-intubation complications is unclear.
UNASSIGNED: This retrospective, observational, multicenter cohort study enrolled 3271 consecutive elderly patients (≥75 years) who received invasive mechanical ventilation (MV) in four medical centers of Chinese PLA General Hospital from 2008 to 2020. AKI was diagnosed according to the 2012 KDIGO criteria by an absolute increase in serum creatinine of ≥26.5 µmol/L within the first 48 hours of MV. We recorded subsequent in-hospital complications, including incident gastrointestinal bleeding, new-onset electrolyte imbalances, severe hypoxemia, hypoalbuminemia, cardiovascular instability and all-cause 90-day mortality.
UNASSIGNED: A total of 1292 patients were included in the final evaluation, with 29.1% presenting AKI (stage 1: 31.4%, stage 2: 35.1%, stage 3: 33.5%). Multiple regression analyses show that more advanced AKI increased the risk of MAP <65 mmHg (stage 1: OR=1.833, P=0.002; stage 2: OR= 4.653, P<0.001; stage 3: OR=4.834, P<0.001) and SBP <90 mmHg (stage 1: OR=1.644, P=0.014; stage 2: OR=3.701, P<0.001; stage 3: OR=5.750, P<0.001), a new need for or requiring an increased dose of vasopressors (stage 1: OR=1.623, P=0.014; stage 2: OR=3.250, P<0.001; stage 3: OR=12.132, P<0.001), gastrointestinal bleeding (stage 1: OR=1.102, P=0.669; stage 2: OR=1.471, P=0.060; stage 3: OR=2.377, P<0.001), severe hypoxia (stage 1: OR=1.213, P=0.399; stage 2: OR=1.449, P=0.077; stage 3: OR=2.214, P<0.001) and all-cause 90-day mortality (stage 1: OR =0.935; P=0.741; stage 2: OR=1.888; P=0.001; stage 3: OR=12.584; P<0.001).
UNASSIGNED: Our study suggests that the presence of AKI within the first 48 hours of MV in geriatric patients is associated with a higher risk for postintubation complications and 90-day mortality. Moreover, the risk of complications was greater for patients with more severe AKI.