Injuria renal aguda: Características clínicas y epidemiológicas y función renal al alta en un hospital en Perú / Acute kidney injury: Clinical and epidemiological features and kidney function at discharge in a hospital in Peru

Objetivo: Describir las características de la Injuria Renal Aguda (IRA) en pacientes hospitalizados en un hospital de tercer nivel de enero a abril del 2016. Material y métodos: Estudio descriptivo, transversal y retrospectivo que incluyó a los pacientes que ingresaron a los servicios de hospitalización de Medicina y Unidad de Cuidados Intensivos. El diagnóstico de IRA y su clasificación según severidad fueron establecidos según los criterios propuestos por Kidney Disease: Improving Global Outcomes. La función renal al alta fue evaluada mediante la estimación de la tasa de filtración glomerular (TFG). Resultados: La frecuencia general de IRA fue 64,83%. En el servicio de Medicina, la frecuencia fue 57,06% y en UCI, 88,14%. La mortalidad general fue 27,45%. Los pacientes con IRA presentaron anemia, diabetes y enfermedad renal crónica en 84,97%, 20,92% y 19,61%, respectivamente. Según severidad, la frecuencia general fue estadio 3: 46,41%, estadio 1: 30,07% y estadio 2: 23,53%. Las categorías de etiología probable más frecuentes fueron intrínseca (41,83%), pre-renal (27,45%) y multifactorial (15,03%). La mediana de TFG al alta en los pacientes que estuvieron en UCI fue 114,40 ml/min/1,73 m2 y en Medicina, 84,89 ml/min/1,73 m2. Según severidad, la menor mediana de TFG al alta se presentó en los pacientes con estadio 3 y, según etiología probable, aquellos que desarrollaron IRA intrínseca y multifactorial presentaron menor función renal al alta. Conclusiones: IRA es un trastorno frecuente en pacientes hospitalizados. La TFG al alta fue significativamente mayor en los pacientes en UCI que en aquellos en Medicina.

Objetive: To describe the characteristics of Acute Kidney Injury (AKI) in hospitalized patients in a tertiarylevel hospital from January to April of 2016. Material and methods: Retrospective descriptive study that included patients admitted to medical ward and Intensive Care Unit. AKI diagnosis and severity stage were established according to Kidney Disease: Improving Global Outcomes criteria. Kidney function at discharge was evaluated by estimating the glomerular filtration rate (GFR). Results: Overall frequency of AKI was 64.83%. In the medical ward, frequency was 57.06% and in ICU, 88.14%. Overall mortality was 27.45%. The proportion of patients with AKI who had anemia, diabetes and chronic kidney disease was 84.97%, 20.92% and 19.61%, respectively. According to severity stage, the overall frequency was stage 3: 46.41%, stage 1: 30.07% and stage 2: 23.53%. The most frequent categories of probable etiology were intrinsic (41.83%), prerenal (27.45%) and multifactorial (15.03%). The GFR median at discharge in ICU was 114.40 ml/min/1.73 m2, whereas in medical ward, 84.89 ml/min/1.73 m2. According to the severity stage, the lowest GFR median at discharge occurred in patients with stage 3 and, according to probable etiology, those who developed intrinsic and multifactorial AKI had lower kidney function at discharge. Conclusions: AKI is a frequent disorder in hospitalized patients. The GFR at discharge was significantly higher in patients who were in ICU than in medical ward.

Epidemiología de la injuria renal aguda y enfermedad renal crónica en la unidad de cuidados intensivos / Epidemiology of acute kidney injury and chronic kidney disease in the intensive care unit

RESUMEN Objetivo: Describir la epidemiología de la injuria renal aguda, la relación con la enfermedad renal crónica y los factores asociados a su incidencia. Métodos: Estudio de cohorte y seguimiento en una unidad de terapia intensiva de Montevideo - Uruguay. Se incluyeron pacientes ingresados entre noviembre 2014 a octubre 2015, mayores de 15 años con dos mediciones de creatinina sérica. Se excluyeron pacientes con menos de 48 horas de internación o fallecidos en ese tiempo y portadores de enfermedad renal crónica en hemodiálisis o diálisis peritoneal. No hubo intervenciones. La injuria renal aguda se definió según criterios Acute Kidney Injury Disease Improving Global Outcomes y la enfermedad renal crónica según Cronic Kidney Disease Work Group. Resultados: Se incluyeron 401 pacientes, sexo masculino 56,6%, mediana de edad 68 (rango intercuartílico - RIC 51 - 79) años. El diagnóstico al ingreso fue sepsis grave 36,3%, neurocrítico 16,3%, politrauma 15,2% y otros 32,2%. La incidencia de injuria renal aguda fue de 50,1%. El 14,1% eran portadores de enfermedad renal crónica. La incidencia de injuria renal aguda séptica fue de 75,3%. La mortalidad en los pacientes con o sin injuria renal aguda fue de 41,8 y 14% respectivamente (p < 0,001). En el análisis multivariado las variables de mayor significación para la injuria renal aguda fueron enfermedad renal crónica (odds ratio - OR 5,39 IC95% 2,04 - 14,29 p = 0,001), shock (OR 3,94 IC95% 1,72 - 9,07 p = 0,001) y sepsis grave (OR 7,79 IC 95% 2,02 - 29,97 p = 0,003). Conclusión: La incidencia de injuria renal aguda es elevada principalmente en pacientes sépticos. La enfermedad renal crónica se asoció de forma independiente al desarrollo de injuria renal aguda.

ABSTRACT Objective: To describe the epidemiology of acute kidney injury, its relationship to chronic kidney disease, and the factors associated with its incidence. Methods: A cohort study and follow-up were conducted in an intensive care unit in Montevideo, Uruguay. We included patients admitted between November 2014 and October 2015 who were older than 15 years of age and who had at least two measurements of serum creatinine. We excluded patients who were hospitalized for less than 48 hours, patients who died at the time of hospitalization, and patients with chronic renal disease who were on hemodialysis or peritoneal dialysis. There were no interventions. Acute kidney injury was defined according to the criteria set forth in Acute Kidney Injury Disease: Improving Global Outcomes, and chronic kidney disease was defined according to the Chronic Kidney Disease Work Group. Results: We included 401 patients, 56.6% male, median age of 68 years (interquartile range (IQR) 51-79 years). The diagnosis at admission was severe sepsis 36.3%, neurocritical 16.3%, polytrauma 15.2%, and other 32.2%. The incidence of acute kidney injury was 50.1%, and 14.1% of the patients suffered from chronic kidney disease. The incidence of acute septic kidney injury was 75.3%. Mortality in patients with or without acute kidney injury was 41.8% and 14%, respectively (p < 0.001). In the multivariate analysis, the most significant variables for acute kidney injury were chronic kidney disease (odds ratio (OR) 5.39, 95%CI 2.04 - 14.29, p = 0.001), shock (OR 3.94, 95%CI 1.72 - 9.07, p = 0.001), and severe sepsis (OR 7.79, 95%CI 2.02 - 29.97, p = 0.003). Conclusion: The incidence of acute kidney injury is high mainly in septic patients. Chronic kidney disease was independently associated with the development of acute kidney injury.

Idosos queimados assistidos em centro de referência para queimados, no Distrito Federal, Brasil, no período de 2002 a 2012 / Burned elderly assisted at a referral center for burns, in the Federal District, Brazil, in the period 2002-2012 / Ancianos quemados asistidos en centro de referencia para quemados, en el Distrito Federal, Brasil, en el período de 2002 a 2012

Objetivou-se analisar tipo, extensão, gravidade, tratamento, prognóstico e letalidade de idosos queimados assistidos no centro de referência de queimados em Brasília, Distrito Federal, Brasil, no período de 2002 a 2012, mediante a realização de estudo retrospectivo, descritivo, e analítico, com dados coletados nos prontuários de pacientes, a partir de 60 anos. 93% das queimaduras foi por acidente; 7% por lesões auto-provocadas; 42% dos casos ocorreram na residência, por chama direta (36%), escaldadura (21%), letalidade de 21% por infecção da corrente sanguínea (29%). A prevenção, o rápido encaminhamento, e o treinamento de equipes se mostram essenciais no prognóstico de idosos queimados.

This study aimed to analyzed the type, extent, severity, treatment, prognosis and lethality of burned elderly people attended at the Burn Reference Center in Brasília, Federal District, Brazil, from 2002 to 2012, through a retrospective, descriptive study And analytical data collected from patients' charts from 60 years. In 93% of the burns it was by accident; 7% from self-inflicted injuries; 42% of the cases occurred in the home, due to direct flame (36%), scald (21%), lethality 21% from bloodstream infection (29%). Prevention, rapid referral, and team training are essential in the prognosis of the burned elderly.

Se analizó el tipo, extensión, gravedad, tratamiento, pronóstico y letalidad de ancianos quemados asistidos en el centro de referencia de quemados en Brasilia, del Distrito Federal, Brasil, en el período de 2002 a 2012, mediante la realización de estudio retrospectivo, descriptivo, descriptivo y analítico con datos recogidos de los prontuarios de pacientes a partir de 60 años. En el 93% de las quemaduras fue por accidente; 7% por lesiones auto-provocadas; El 42% de los casos ocurrieron en la residencia, por llama directa (36%), escaldadura (21%), letalidad del 21% por infección del torrente sanguíneo (29%). La prevención, el rápido encaminamiento y el entrenamiento de equipos se muestran esenciales en el pronóstico de los ancianos quemados.

Characteristics of Injury in a University Hospital / 한국역학회지

PURPOSE: This study was performed to provide the basic data in the establishment of preventive countermeasures for injury by analyzing the characteristics of injury, and risk factors of injury. METHODS: From 2,059 injury patients among 19,947 patients admitted between January and December, 2004 at a university hospital located in Gyeonggi-do, 500 injury patients were sampled randomly by systematic sampling. A total of 500 questionnaires was collected and used for this study. The statistical SPSS was used to analyze data that included chi-square, fisher's exact test. RESULTS: Injury patients among total admission patients was 10.3%. In both general characteristics of injury and non-injury patients, gender, age, length of stay was significant. As the cause of injury were compared with those of injury external causes, type, place, site, and time of injury were significant. As the cause of injury were compared with the characteristics of related-injury, surgery, multiple injuries, mental history, consciousness at the time emergency room visit, length stays were significant. CONCLUSION: With regard to general characteristics, injury external causes, injury-related causes, and factors such as sex, age, occupation, and educational background were related to each other. Injury does not occur by accident or unexpectedly. Therefore, if preventive attention is focused on individuals with high risk factors of injury, the incidence rate will be diminished.

Epidemiology Characteristics of Spinal Cord Injury in Hospital:1264 Cases Report / 中国康复理论与实践

@#Objective To investigate the epidemiology characteristics of spinal cord injury(SCI)in hospital.Methods1264 inpatients with SCI during April 1992～August 2006 were analyzed retrospectively.Results and Conclusion56.1% of the cases were 20～40 years old.Traffic trauma(44.3%)and fall injury(21.8%)were the main causes of SCI.The incidences of affected segments were:cervical segments 31.5%,thoracolumbar 28.1%,and thoracic 21.3%.56.7% were complete injury and 43.3% were incomplete.The most frequent complication of SCI were:urinary tract infection,pressure sore and bladder lithiasis.The expenditure of hospitalization was provided by oneself(52.5%),public medicalcare(33.1%),only 4.1% by hospitalization insurance.

2002年北京市脊髓损伤发病率调查 / 中国康复理论与实践

@#Objective To survey the situation of spinal cord injuries (SCI) in Beijing.Methods China Rehabilitation Research Center and Information Center of Beijing Health Bureau sponsored the surveillance of 86 hospitals in Beijing which had hospitalized SCI patients in 2002. The faculty of surveillance was composed of trained professionals. The number of registered SCI patients in 2002 was 1077, and 264 patients in 11 hospitals were chosen to be investigated in detail according to stratified sampling result.Results There were 1077 registered patients with a neurological deficit and the annual SCI incidence was 60 per million. The ratio of male to female was 3:1 and the ratio of cervical, thoracic, lumbar injuries and others is 4.9%, 28%, 66.7%, 0.4% respectively. The mean age at the time of injury was 41 years. The causes most frequently seen were falls from a height and traffic accidents. The mean time of hospitalization was 18.9 days and the mean expenditure of hospitalization was 27819.3 RMB. Four patients were transferred to rehabilitation hospitals, and others went homes directly after discharge.Conclusion There are many reasons for the high annual SCI incidence in Beijing and the first SCI cause was falling from a height, which should be pay special attention when the prevention measures are taken into account. The rate of SCI patients who received systemic medical rehabilitation was low.