Maladi ren egi apre echèk kè dekonpanse egi

Konklizyon:AKD apre ADHF asosye ak rezilta negatif. Modèl nou an ta ka ede nan idantifikasyon pasyan ki gen risk pou devlopman AKD, espesyalman nan moun ki pa t 'gen yon epizòd endèks AKI.

EXTRÈ CISTANCHE AK 30% ECHINCAOSIDEPOU MALADI REN

ADHF is a poor prognostic event in patients with congestive heart failure, with a 1-year death rate of >30% and a high readmission rate.1,2 The condition usually occurs alongside AKI. The incidence of AKI among those admitted for ADHF varies from 9.6% to 43%.3–5 AKI, as a common complication of ADHF (i.e., acute cardiorenal syndrome type 1 in ADHF), is associated with higher 1-year death and readmission rates.3,4,6 The poor prognostic effect is more significant in those who developed AKI or worse renal function but without effective decongestion.7 AKD represents a continuum of kidney injury or renal function nonrecovery after initial kidney insult/ stress. In addition, the transition from AKI to AKD, to chronic kidney disease (CKD) reflects a continuum of persistent kidney injury after initial kidney insult.8 The time course for AKD is described as >7 jou men nan lespas 90 jou apre yo kòmanse AKI. Definisyon AKD aktyèl la baze sou konsansis Gwoup Travay Inisyativ Kalite Maladi Aigu 16.8 Se poutèt sa, AKD ta ka konsidere kòm yon kondisyon ki pwolonje malfonksyònman ren (nan prezans oswa absans AKI) rive anvan yon pasyan satisfè {{4 }}kritè jou pou CKD.8,9 Konpare ak rechèch sa yo sou AKI, etid ki mennen ankèt sou ensidans ak enpak pronostik AKD nan pasyan yo admèt pou ADHF yo ra. Gen kèk etid ki evalye faktè klinik ki gen rapò ak devlopman AKI/CKD oswa modèl prediksyon pou pasyan ki gen ADHF, men kèk nan yo te adrese devlopman AKD apre ADHF.4,10-18.

Figi 1. Organigram pou (a) seleksyon pasyan ak (b) distribisyon diferan etap AKI ak AKD. AKD, maladi ren egi; AKI, blesi nan ren egi; ECMO, oksijenasyon manbràn ekstrakòporèl; ESRD, maladi ren fen-etap; RRT, terapi ranplasman ren.

Nan etid sa a, nou te envestige ensidans, faktè klinik, ak enpak pronostik AKD apre ADHF. Nou devlope tou yon modèl prediksyon pou AKD apre ADHF pou fasilite stratifikasyon risk e konsa ankouraje idantifikasyon ak entèvansyon AKD bonè.

METÒD

Sous Done

Sa a se te yon etid kowòt retrospektiv lè l sèvi avèk done elektwonik ki soti nan baz done rechèch Chang Gung (CGRD). Chang Gung Medical Foundation se pi gwo sistèm medikal nan Taiwan, ki gen 7 lopital ki kouvri tout Taiwan. CGRD se yon baz done dosye medikal elektwonik milti-enstitisyonèl ki bay plis enfòmasyon klinik detaye, tankou rezilta laboratwa ak dosye emodinamik, pase baz done reklamasyon epi ki gen gwo pwoteksyon jeneral ak maladi espesifik nan Taiwan.19,20 maladi ki te evalye nan etid sa a te idantifye lè l sèvi avèk Klasifikasyon Entènasyonal Maladi (ICD), Nevyèm Revizyon, Kòd dyagnostik Modifikasyon Klinik pou dosye anvan 2015, ak Kòd dyagnostik ICD, Dizyèm Revizyon, Modifikasyon Klinik pou moun apre 2016. Estrikti done ak validasyon nan yo diskite sou CGRD yo yon lòt kote.20–22 Komisyon Konsèy Revizyon Enstitisyonèl Chang Gung Memorial Hospital te apwouve etid sa a (nimewo Komisyon Konsèy Revizyon enstitisyonèl: 202000915B0). Yo te anile bezwen pou konsantman endividyèl paske done idantifikasyon pèsonèl yo pa enkli nan CGRD. Etid sa a te fèt dapre deklarasyon STROBE (Materyèl Siplemantè).

Etid Popilasyon

Patients who were admitted for ADHF (identified by ICD, Ninth Revision, Clinical Modification: 428 and ICD, Tenth Revision, Clinical Modification: I50 in the hospital primary and secondary diagnosis during hospitalization) between January 1, 2008, and December 31, 2018, and who had sufficient data to determine the presence of AKI and AKD were identified in the CGRD. The use of ICD, Ninth Revision, Clinical Modification: 428 and ICD, Tenth Revision, Clinical Modification: I50 for identified ADHF hospitalized population is verified in other studies23,24 and with positive predictive value >90%.25,26 Pou pasyan ki gen plizyè admisyon ADHF pandan peryòd etid la, yo te itilize premye admisyon ADHF kòm admisyon endèks la. Pasyan yo te eskli si yo te<18 years old, were diagnosed with having end-stage renal disease and already on maintenance dialysis, or were on extracorporeal membrane oxygenation during the index admission. Patients with anticipated cardiac transplantation, who were diagnosed with having sepsis or obstructive uropathy, were exposed to a nephrotoxic agent during admission (including iodine contrast media, a nonsteroidal anti-inflammatory drug, aminoglycosides, or vancomycin), or developed severe AKI requiring dialysis were also excluded (Figure 1a).

Definisyon AKI ak AKD

Prezans AKI te detèmine selon laMaladi ren: Improving Global Outcomes AKI criteria, which is by comparing a patient's baseline creatinine levels with their highest creatinine level during the first 7 days of their index admission.27 For the baseline creatinine level, we used the lowest creatinine level in the 3 months before the index admission or, if no creatinine level within 3 months of the index admission was available, the first creatinine level in the same index admission. The first AKI episode in the index admission is identified as index AKI. The presence of AKD was determined based on consensus from the Acute Disease Quality Initiative 16 Workgroup.8 AKD is defined by a condition in which persisted AKI is present $7 days after an AKI initiating event. The Acute Disease Quality Initiative workgroup also mentioned that an AKI-initiating event can usually be identified but is not required to diagnose AKD.8,9 For AKD staging, the baseline creatinine level was compared with the creatinine level nearest to 90 days after the index admission; AKD stages 1 and 2 were defined as serum creatinine levels 1.5 to 1.9 and 2.0 to 2.9 times baseline, respectively, whereas stage 3 was defined as a serum creatinine level 3.0 times baseline, serum creatinine increase of $4.0 mg/dl, or being on renal replacement therapy for 8 to 90 days after the index date. If >Yo te jwenn 1 valè pandan 8 a 90 jou apre admisyon endèks la, yo te detèmine prezans AKD ki baze sou nivo kreyatinin ki te pran pi pre 90yèm jou apre admisyon endèks la.

Prediktè potansyèl (kovaryè)

Karakteristik klinik pasyan yo, faktè sansiblite AKI, 4,10–17,28–30, ak faktè ren nonrecovery pou ensifizans kadyak konjestif oswa popilasyon maladi grav31–35 yo te idantifye dapre etid anvan yo oswa disponiblite a nan seri done nou an. Faktè risk yo ekstrè yo enkli laj, sèks, maladi kache (sa vle di, dyabèt melitus, tansyon wo, CKD, siwoz fwa, ak malignité), evalyasyon fonksyon kè pa klas fonksyonèl New York Heart Association,36, ak fraksyon vantrikulè gòch. Paramèt emodinamik (tansyon sistolik, tansyon dyastolik, ak batman kè) lè yo rive nan sal ijans la oswa nan jou admisyon an, premye rezilta laboratwa pandan admisyon endèks (ki gen ladan emoglobin [HB]; nitwojèn ure nan san [BUN]; serom). kreyatinin, albumin, sodyòm, potasyòm, proteinuria, ak nivo B-tip natriuretic peptide [BNP]), ak preskripsyon medikaman ki gen rapò (diiretik bouk pou pasyan ekstèn nan 3 mwa anvan yo ak dòz kimilatif diiretik bouk pandan admisyon ADHF, digoksin, inotrop, oswa dobutamin). itilize pandan admisyon endèks la) yo te tou ekstrè.

Definisyon rezilta

Te gen 2 rezilta prensipal nan etid sa a, ki se sa ki annapre yo: (i) devlopman nenpòt etap nan AKD ak (ii) yon rezilta konpoze etap 3 AKD oswa lanmò tout kòz pandan uityèm ak 90yèm jou apre admisyon nan endèks la. . Rezilta segondè yo se lanmò tout kòz, MAKE, ak HFH soti nan 91yèm jou a jiska senkyèm ane apre admisyon nan endèks. MAKE te konpoze de yon nouvo dyagnostik nan fen etap maladi ren ki mande alontèm terapi ranplasman ren, nouvo CKD aparisyon (ki defini nan pousantaj filtraj glomerulè estime).<60 ml/ min per 1.73 m2 according to the Modification of Diet in Renal Disease equation), and all-cause death.

Analiz estatistik

Karakteristik debaz pasyan ki gen ak san AKI oswa AKD yo te konpare lè l sèvi avèk echantiyon t-tès endepandan pou varyab kontinyèl ak tès c2 pou varyab kategorik. Yo te itilize analiz regresyon lojistik inivaryab pou premye tès depistaj posib asosyasyon ki genyen ant karakteristik debaz ak risk rezilta yo. Covariates ak yon siyifikasyon nan<0.2 in the univariate logistic regression analyses were further introduced into a multivariable model with automatic backward elimination. In the multivariable model, continuous parameters (i.e., systolic blood pressure, diastolic blood pressure, heart rate, HB, BUN, creatinine, potassium, and albumin) were categorized based on previous reports or according to clinical definitions.4,10–17 The models for predicting any-stage AKD, the composite of stage 3 AKD and all-cause death, and all-cause death alone were developed separately. 

Modèl prediksyon klinik ak laboratwa ki baze sou analiz lojistik miltivaryab la te transfòme plis nan yon sistèm pwen senplifye pou fasilite itilizasyon klinik la.37 Lide kle sistèm pwen senplifye a se awondi koyefisyan regresyon yo. Premye etap la se te idantifye yon prediktè kontinyèl ak yon pakèt valè kòm varyab referans (sa vle di, BNP) ak Lè sa a, kategorize varyab sa a nan plizyè kategori klinikman sans epi jwenn valè referans (anjeneral valè nan mitan) pou chak kategori nan varyab la. . Prediktè ki pa varyab referans yo te tou klase kòmsadwa. Finalman, yo te kalkile valè referans (anjeneral valè mitan an) nan chak kategori nan prediktè a dapre valè koyefisyan regresyon li yo parapò ak sa yo ki nan varyab referans la.

sistèm pwen. Risk lanmò tout kòz, MAKE, ak HFH atravè sougwoup risk ordinal yo te envestige lè l sèvi avèk analiz siviv yo mansyone pi wo a, kote yo te trete sougwoup risk ordinal la kòm yon kovarye kontinyèl. Tout analiz yo te fèt ak R vèsyon 4.0.1 (R Development Core Team).