Incidence, aetiology and outcome of community-acquired acute kidney injury in medical admissions in Malawi
Objective: To compare the long-term outcomes of hospitaland community-acquired acute kidney injury (AKI) in Xinjiang and investigate prognostic factors of 3-years all-cause mortality for AKI patients. Methods: Clinical data were screened and collected from the electronic records in the hospital network system of 19528 adult patients admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2013 to July 2016. The study cohort consisted of 352 patients who were reconfirmed according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. They were divided into hospital-acquired acute kidney injury (HA-AKI) group and community-acquired AKI (CA-AKI) group in terms of time of onset of AKI. All patients were followed up for 3 years. Clinical data and the results of laboratory examination were collected. Comparison of long-term outcomes between patients with HA-AKI group and those with CA-AKI was performed using the Log rank test, and prognostic factors of 3-years all-cause mortality in AKI patients were analyzed using the Cox regression. Results: The 1-year all-cause mortality was significantly different between patients with CA-AKI (41.8%, 89/213) and HA-AKI (56.8%, 79/139) (P<0.05), but the 3-year all-cause mortality showed no significant differences between the two groups (60.1% (128/213) of the CA-AKI group and 64% (89/139) of the HA-AKI group). The multivariate Cox regression model with data from 352 AKI patients indicated that the risk factors related to 3-year outcomes in the AKI patients included increased MODS scores, increased total cholesterol, reduced plasma albumin, decreased ratio of neutrophile granulocyte and leukomonocyte, reduced platelet counts, and low mean arterial pressure. The area under the receiver operator characteristic (ROC) curve in the regression equation Y was 0.795, which is of significance for outcome prediction. Conclusion: There was no difference in 3-year all-cause mortality between HA-AKI group and CA-AKI group. MODS scores, total cholesterol, plasma albumin, ration of neutrophile granulocyte and leukomonocyte, blood platelet and mean arterial pressure is related to prognosis of AKI patients.