Epidemiology of acute kidney injury（AKI） in inpatients：a single center retrospective observational study
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摘要:
目的：研究住院患者急性肾损伤（acute kidney injury，AKI）的发病、病因及诊断情况。方法：筛选南京医科大学第一附属医院2013年10月—2014年9月收治的18岁以上符合AKI定义的患者，进行横断面研究。分析住院患者的AKI发病、病因、诊断情况和分布科室等。结果：①AKI发病率为1.61%（1 401/87 196），男女比例为2.03∶1、平均年龄（63.2±37.2）岁、城市人口占58.3%、中位住院时间18（11～28）d、中位住院花费5.72（2.50~12.16）万元。住院期间肾脏功能完全恢复/部分恢复的占66.5%，30 d病死率为35.3%；②AKI实际检出率0.76%，及时诊断率44.0%、延迟诊断率3.3%、漏诊率52.7%；肾科患者AKI的诊断率（89.3%）最高，外科患者诊断率最低，漏诊率高达75.1%；③AKI的发病情况因科室而异：肾科3.5%，其他内科1.3%，外科1.0%，重症监护病房（intensive care unit，ICU）18.0%；诊断AKI的患者中肾科、其他内科、外科、ICU分别占7.4%、37.1%、30.1%、25.4%；心内科、血液科、胸心外科、ICU是AKI发生的相对高危科室；④按AKI病因，肾前性、肾性、肾后性分别占42.1%、52.2%、5.7%；其中肾前性组年轻患者比例高，基础肾功能好，但漏诊率最高（85.7%）；⑤本研究AKI 1期、2期、3期患者分别占38.0%、22.1%、40.0%，随AKI分期越高，及时诊断率越高，漏诊率越低，但ICU住院时间越长，肾功能恢复越差，30 d病死率越高。结论：AKI在住院患者中较常见，检出率低，漏诊率高。各科医师要加强AKI诊断标准的学习和高危因素的识别，建立AKI预警系统，及早发现和诊断，以改善AKI预后。
Abstract:
Objective：To investigate the incidence，etiology and diagnosis of acute kidney injury （AKI） in hospitalized patients. Methods：From October 2013 to September 2014，hospitalized patients meeting AKI （KDIGO，2012） definition and beyond 18 years old were screened for a cross-sectional study. The incidence，etiology，diagnosis and departments distributing of AKI patients were analyzed by SAS. Results：（1）The incidence of AKI was 1.6% （1401/87196），male to female ratio was 2.03：1，average age was 63.2±37.2，urban population accounted for 58.3%，the median length of stay was 18 （11，28） days，and median costs was 57.2（25.0-121.6） thousand Yuan. Patients whose renal function recovered completely or partially accounted for 66.5%，and 30 d mortality was 35.3% correspondingly. （2）AKI detection rate，timely diagnosis，delayed diagnosis，and missed diagnosis rate were 0.76%，44%，3.3% and 52.7%，respectively. Renal patients were characterized by highest AKI diagnosis rate （89.3%），while the surgical patients were at the lowest level with missed diagnosis rate of 75.1%. （3） The incidence of AKI varied by different departments：3.5% for nephrologie，1.3% for other internal，1.0% for surgery，and 18% for ICU. Nephrology，other internal，surgery and ICU accounted for 7.4%，37.1%，30.1% and 25.4% of the patients diagnosed with AKI，respectively. Cardiology，hematology，cardiothoracic surgery and ICU had a highrisk of AKI. （4） According to the etiology of AKI，prerenal，renal and post-renal accounted for 42.1%，52.2% and 5.7%，respectively. And prerenal was characterized with higher percentage of young patients with good original renal function； however，the missed diagnosis rate was as high as 85.7%. （5）AKI patients at stage 1，2 and 3 accounted for 38.0%，22.1% and 40.0%，respectively. As AKI stage upgraded，timely diagnosis rate was increased and missed diagnosis rate was decreased，however，it was accompanied by longer AKI stay，worse renal function recovery and higher 30 d mortality. Conclusion：AKI was generally characterized with common occurrence，low detection rate and high missed diagnosis rate. AKI criteria and recognition of high-risk factors needed to be spread among physicians in order to improve prognosis of AKI. Warning system for AKI should be established to improve early detection and diagnosis.
