米国における急性腎損傷が熱中症で入院した患者の転帰に及ぼす影響

Impact of Acute Kidney Injury on Outcomes of Hospitalizations for Heat Stroke in the United States.

• Charat Thongprayoon
• Fawad Qureshi
• Tananchai Petnak
• Wisit Cheungpasitporn
• Api Chewcharat
• Liam D Cato
• Boonphiphop Boonpheng
• Tarun Bathini
• Panupong Hansrivijit
• Saraschandra Vallabhajosyula
• Wisit Kaewput

抄録

この研究は、米国の熱中症で入院した患者における急性腎障害の危険因子および治療、合併症、転帰、資源利用との関連を評価することを目的としている。2003 年から 2014 年までに熱中症の一次診断を受けた入院患者を National Inpatient Sample データセットで同定した。末期腎疾患患者は除外した。入院中の急性腎障害の発生は、病院診断コードを用いて同定した。急性腎障害と臨床的特徴、院内治療、転帰、および資源利用との関連を多変量解析を用いて評価した。合計3346人の入院患者が解析に含まれた。急性腎障害は1206例（36％）の入院患者で発生し、そのうち49例（1.5％）が透析を必要とした。急性腎障害の危険因子は、20～39歳、アフリカ系アメリカ人人種、肥満、慢性腎臓病、うっ血性心不全、横紋筋融解症であったが、20歳未満または60歳以上では急性腎障害のリスクが低かった。急性腎障害が発生した場合、機械換気と輸血の必要性が高くなった。急性腎障害は、電解質および酸塩基の異常、敗血症、急性心筋梗塞、心室性不整脈または心停止、呼吸器、循環器、肝臓、神経学的、血液学的障害、および院内死亡と関連していた。入院期間、入院費用は急性腎不全患者で高かった。熱中症患者の約 3 分の 1 が入院中に急性腎障害を発症した。急性腎障害は、いくつかの合併症と関連し、死亡率と資源利用率が高かった。

This study aims to evaluate the risk factors and the association of acute kidney injury with treatments, complications, outcomes, and resource utilization in patients hospitalized for heat stroke in the United States. Hospitalized patients from years 2003 to 2014 with a primary diagnosis of heat stroke were identified in the National Inpatient Sample dataset. End stage kidney disease patients were excluded. The occurrence of acute kidney injury during hospitalization was identified using the hospital diagnosis code. The associations between acute kidney injury and clinical characteristics, in-hospital treatments, outcomes, and resource utilization were assessed using multivariable analyses. A total of 3346 hospital admissions were included in the analysis. Acute kidney injury occurred in 1206 (36%) admissions, of which 49 (1.5%) required dialysis. The risk factors for acute kidney injury included age 20-39 years, African American race, obesity, chronic kidney disease, congestive heart failure, and rhabdomyolysis, whereas age <20 or ≥60 years were associated with lower risk of acute kidney injury. The need for mechanical ventilation and blood transfusion was higher when acute kidney injury occurred. Acute kidney injury was associated with electrolyte and acid-base derangements, sepsis, acute myocardial infarction, ventricular arrhythmia or cardiac arrest, respiratory, circulatory, liver, neurological, hematological failure, and in-hospital mortality. Length of hospital stay and hospitalization cost were higher in acute kidney injury patients. Approximately one third of heat stroke patients developed acute kidney injury during hospitalization. Acute kidney injury was associated with several complications, and higher mortality and resource utilization.