加拿大Alberta Calgary大學Matthew T. James醫師等作者指出，在整個住院期間，週末入院的校正高死亡率風險範圍從大型醫院的7%到小型機構的17%。
作者們在線上發表於4月15日美國腎臟學會期刊(Journal of the American Society of Nephrology)的報告中寫道，這些差異看起來或許相對中等，但是，根據這些估計，我們推算，在週末入院的AKI病患中，每年多出將近4000例死亡，也就是說，每65個週入住院的AKI病患就多1個人死亡。
Weekend Admission Associated With Higher Mortality From Acute Kidney Injury
By Norra MacReady
Medscape Medical News
April 15, 2010 — People admitted to the hospital with acute kidney injury (AKI) are 22% more likely to die by day 3 of their stay if they come in over the weekend than on a weekday, a new study shows.
The difference was most pronounced at smaller hospitals, where weekend admission was associated with a 35% increase in adjusted 3-day mortality risk versus weekday admission compared with a 24% increase at large hospitals.
Over the total length of hospital stay, the adjusted excess mortality risk associated with weekend admission ranged from 7% at larger hospitals to 17% at smaller institutions, report the authors, led by Matthew T. James, MD, from the University of Calgary, Alberta, Canada.
These differences may appear relatively modest, but "on the basis of these estimates, we project that approximately 4000 additional deaths per year occur in patients with AKI admitted on the weekend, representing 1 additional death for every 65 weekend admissions with AKI," the authors write in their report, published online April 15 in the Journal of the American Society of Nephrology.
Using data from a large database of admissions to private, acute-care hospitals in the United States, the authors identified 963,730 patients admitted with diagnoses including AKI between 2003 and 2006. AKI was the primary diagnosis for 214,962 of those patients: 169,759 admitted on a weekday, and 45,203 on a weekend. A total of 14,686 (6.8%) of patients with a primary diagnosis of AKI died, including 7.3% admitted on a weekend and 6.7% admitted on a weekday.
After adjustment for age, sex, race, comorbidities, and the need for mechanical ventilation, the authors found that "weekend admission with AKI remained associated with a 22% increased odds of death by day 3 of admission and a 7% increase for the duration of the hospital stay." Weekend admission also was associated with a 20% increase in the odds of receiving mechanical ventilation and a 6% decrease in the odds of undergoing dialysis.
The pattern was similar for mortality associated with 7 other primary diagnoses to which AKI was secondary: weekend admission was associated with a consistently higher risk compared with admission on a weekday.
The reasons for the disparity are unclear. Other researchers have described delays in the diagnosis and management of other acute medical conditions when patients are admitted over the weekend, and this may be true for patients with AKI as well. Weekend admission "may delay the provision of some elements of care, including diagnostic and therapeutic interventions," the current study authors write, such as dialysis or nephrology consultations, although more data are needed to confirm that suggestion.
However, dialysis rates did not vary that much between the groups, so it is not certain what role, if any, small difference played in these findings, William McClellan, MD, from Emory University, Atlanta, Georgia, writes in an accompanying editorial. With more evidence showing the contribution of these and other factors such as timely and appropriate diagnosis, infection control, nondialytic management of volume, and nutritional support, "it would be possible to draw inferences about the weekday-to-weekend and hospital-to-hospital variability in mortality of patients with AKI. In turn, this information could be used to address variations in care."
Study limitations include the possible failure to identify all patients with AKI; defining "weekend" as Saturday and Sunday rather than including Friday evening and early Monday morning, when care is similar to that provided over the weekend; the exclusion of patients who may have died from AKI-related causes after they left the hospital; and possible confounding resulting from unmeasured characteristics.
All in all, the authors concluded, "these findings highlight the need to further investigate the availability and timing of provision of diagnostic and therapeutic strategies to patients hospitalized with AKI."
The authors have disclosed no relevant financial relationships.
J Am Soc Nephrol. Published online April 15, 2010.
