■已经发表了三种急性肾损伤的共识分类。这些是RIFLE(风险,伤害,失败,肾功能丧失,和急性透析质量倡议工作组发布的终末期肾病),AKIN(由急性肾损伤网络发布)和KDIGO(由肾脏疾病改善全球结果工作组发布)。据报道,急性肾损伤与预后恶化有关。然而,毒性相关的急性肾损伤已被排除在用于验证急性肾损伤分类的研究之外.
■为了研究中毒患者是否会出现急性肾损伤,由共识定义/分类定义,与没有死亡率的人相比,死亡率更高。
■从2004年到2019年,使用以下关键字搜索了数据库(KDIGO或“肾脏疾病:改善全球结果”或“肾脏疾病改善全球结果”或AKIN或“AKI网络”或“急性肾损伤网络”或ADQI或RLEIFE或“急性透析质量倡议”)和(感染或肾中毒或过量)或肾中毒(或肾功能)如果数据可用,我们使用随机效应荟萃分析模型和Fisher精确检验,根据肾功能定义(急性肾损伤vs无)和分期(分期vs无急性肾损伤)比较患者死亡率,分别。如果数据可用,我们评估了死亡率和肾功能之间的相关性(无急性肾损伤,风险/阶段1、伤害/阶段2和失败/阶段3)使用Spearman相关性。如果可用,我们收集了使用急性肾损伤预测死亡率的研究的统计分析结果.
■研究选择。共进行了33项相关研究,22/33的回顾性研究(67%)和11/33的前瞻性研究(33%)。百草枯是最常见的毒物(13/33,39%)。我们发现,在评估死亡率的时间框架方面,研究之间存在差异,被认为是预测死亡率的肾功能的时间性(初始/最差)以及用于定义/分级急性肾损伤的标准.急性肾损伤定义/分期与死亡率之间的单变量关联。急性肾损伤的共识定义/分期与较高的死亡率相关,使用单变量分析,包括28项(RIFLE=7;AKIN=12;KDIGO=9)研究,但不包括5项(AKIN=4,KDIGO=1)。当收集可用数据时,步枪(5项研究),急性肾损伤的AKIN(16项研究)和KDIGO定义(8项研究)与较高的死亡率相关(对数未调整赔率比[95%-置信区间],2.60[2.23;2.97],2.02[1.48;2,52]和3.22[2,65;3.78],分别)。然而,我们发现使用AKIN的研究存在高度异质性(I2=54.7%)和发表偏倚.在有可用数据的十项研究中,肾功能之间的相关性(无急性肾损伤,在5项研究中,风险/1期,损伤/2期,失败/3期)和死亡率显着(RIFLE=2;AKIN=3),但在5项研究中没有(RIFLE=1;AKIN=3;KDIGO=1)。急性肾损伤定义/分期与死亡率之间的多变量关联。在两项研究中,急性肾损伤的定义与较高的死亡率相关(RIFLE=2),但在四项研究中没有(AKIN=1和KDIGO=3。急性肾损伤的阶段(包括一个或多个阶段)与四个(RIFLE=1,AKIN=1和KDIGO=2)的较高死亡率相关。
■所有三个共识定义/分类均与中毒死亡率增加独立相关,但报告急性肾损伤的研究之间存在差异。
UNASSIGNED: Three consensus classifications of acute kidney injury have been published. These are
RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease published by the Acute Dialysis Quality Initiative workgroup), AKIN (published by the Acute Kidney Injury Network) and KDIGO (published by the Kidney Disease Improving Global Outcome workgroup). Acute kidney injury has been reported consistently as associated with worsened outcomes. However, toxicant-related acute kidney injury has been excluded from the studies used to validate the classifications of acute kidney injury.
UNASSIGNED: To study whether poisoned patients who develop acute kidney injury, as defined by consensus definitions/classifications, have higher mortality compared to those who did not.
UNASSIGNED: Databases were searched from 2004 to 2019 using the following keywords (KDIGO OR \"Kidney Disease: Improving Global Outcomes\" OR \"Kidney Disease Improving Global Outcomes\" OR AKIN OR \"AKI network\" OR \"Acute kidney Injury Network\" OR ADQI OR
RIFLE OR \"Acute dialysis quality initiative\") AND (intoxication OR poisoning OR overdose OR ingestion) AND (AKI OR kidney OR renal OR ARF). If data were available, we used a random-effects meta-analysis model and Fisher\'s exact test to compare mortality in patients according to kidney function definitions (acute kidney injury vs not) and stages (stages vs no acute kidney injury), respectively. If data were available, we assessed the correlation between mortality and renal function (no acute kidney injury, risk/stage 1, injury/stage 2 and failure/stage 3) using the Spearman correlation. If available, we collected the results of statistical analyses in studies that have used acute kidney injury to predict mortality.
UNASSIGNED: Study selection. Thirty-three relevant studies were found, 22/33 retrospective studies (67%) and 11/33 prospective studies (33%). Paraquat was the most frequent toxicant involved (13/33, 39%). We found a disparity between studies regarding the timeframe during which mortality was assessed, the temporality of the renal function considered to predict mortality (initial/worst) and the criteria used to define/grade acute kidney injury across studies. Univariate association between acute kidney injury definitions/stages and mortality. Consensus definitions/staging of acute kidney injury were associated with higher mortality, using univariate analyses, in twenty-eight (RIFLE = 7; AKIN = 12; KDIGO = 9) studies included but not in five (AKIN = 4, KDIGO = 1). When available data were pooled,
RIFLE (5 studies), AKIN (16 studies) and KDIGO definitions (8 studies) of acute kidney injury were associated with a higher mortality (Log unadjusted Odds ratios [95%-confidence interval], 2.60 [2.23; 2.97], 2.02 [1.48; 2,52] and 3.22 [2,65; 3.78], respectively). However, we found high heterogeneity (I2=54,7%) and publication bias among studies using AKIN. In ten studies with available data, the correlation between renal function (no acute kidney injury, risk/stage 1, injury/stage 2, failure/stage 3) and mortality was significant in 5 studies (
RIFLE = 2; AKIN = 3), but not in five studies (RIFLE = 1; AKIN = 3; KDIGO = 1).Multivariate association between acute kidney injury definitions/stages and mortality. The definitions of acute kidney injury were associated with higher mortality in two studies (
RIFLE = 2), but not in four studies (AKIN = 1 and KDIGO = 3. The stages of acute kidney injury (including one or more stages) were associated with higher mortality in four (RIFLE = 1, AKIN = 1 and KDIGO = 2).
UNASSIGNED: All three consensus definitions/classifications were associated independently with increased mortality in poisoning but with disparity between studies reporting acute kidney injury.