Background: Acute kidney injury (AKI) is a common complication among cancer patients, often leading to longer hospital stays, discontinuation of cancer treatment, and a poor prognosis. This study aims to provide insight into the incidence of severe AKI in this population and identify the risk factors associated with renal replacement therapy (RRT) and in-hospital mortality. Methods: This retrospective cohort study included 3201 patients with cancer and severe AKI admitted to a Comprehensive Cancer Center between January 1995 and July 2023. Severe AKI was defined according to the KDIGO guidelines as grade ≥ 2 AKI with nephrological in-hospital follow-up. Data were analyzed in two timelines: Period A (1995–2010) and Period B (2011–2023). Results: A total of 3201 patients (1% of all hospitalized cases) were included, with a mean age of 62.5 ± 17.2 years. Solid tumors represented 75% of all neoplasms, showing an increasing tendency, while hematological cancer decreased. Obstructive AKI declined, whereas the incidence of sepsis-associated, prerenal, and drug-induced AKI increased. Overall, 20% of patients required RRT, and 26.4% died during hospitalization. A predictive model for RRT (AUC 0.833 [95% CI 0.817–0.848]) identified sepsis and hematological cancer as risk factors and prerenal and obstructive AKI as protective factors. A similar model for overall in-hospital mortality (AUC 0.731 [95% CI 0.71–0.752]) revealed invasive mechanical ventilation (IMV), sepsis, and RRT as risk factors and obstructive AKI as a protective factor. The model for hemato-oncological patients’ mortality (AUC 0.832 [95% CI 0.803–0.861]) included IMV, sepsis, hematopoietic stem cell transplantation, and drug-induced AKI. Mortality risk point score models were derived from these analyses. Conclusions: This study addresses the demographic and clinical features of cancer patients with severe AKI. The development of predictive models for RRT and in-hospital mortality, along with risk point scores, may play a role in the management of this population.
背景：急性肾损伤（AKI）是癌症患者常见的并发症，常导致住院时间延长、癌症治疗中断及预后不良。本研究旨在探讨该人群中严重AKI的发生率，并识别与肾脏替代治疗（RRT）及院内死亡率相关的风险因素。方法：本回顾性队列研究纳入了1995年1月至2023年7月期间某综合癌症中心收治的3201例合并严重AKI的癌症患者。严重AKI依据KDIGO指南定义为≥2级AKI且住院期间接受肾脏专科随访。数据分析分为两个时间段：A期（1995–2010年）和B期（2011–2023年）。结果：共纳入3201例患者（占全部住院病例的1%），平均年龄为62.5±17.2岁。实体肿瘤占所有肿瘤的75%，呈上升趋势，而血液系统肿瘤比例下降。梗阻性AKI发生率降低，而脓毒症相关AKI、肾前性AKI及药物性AKI的发生率增加。总体而言，20%的患者需要RRT，26.4%的患者在住院期间死亡。针对RRT的预测模型（AUC 0.833 [95% CI 0.817–0.848]）显示脓毒症和血液系统肿瘤为风险因素，肾前性AKI和梗阻性AKI为保护因素。针对总体院内死亡率的类似模型（AUC 0.731 [95% CI 0.71–0.752]）显示有创机械通气（IMV）、脓毒症和RRT为风险因素，梗阻性AKI为保护因素。针对血液肿瘤患者死亡率的模型（AUC 0.832 [95% CI 0.803–0.861]）纳入了IMV、脓毒症、造血干细胞移植及药物性AKI。基于这些分析得出了死亡率风险评分模型。结论：本研究揭示了合并严重AKI的癌症患者的人口学及临床特征。针对RRT和院内死亡率的预测模型及风险评分的建立，可能有助于该人群的临床管理。
肿瘤(癌症)患者之家