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目的:探讨中国成人重症监护病房（ICU）患者按照改善全球肾脏病预后组织急性肾损伤诊断标准（KDIGO-AKI）分型临床结局的差异，分析影响ICU患者临床预后的危险因素。方法:对一项基于中国危重症临床试验组（CCCCTG）建立的危重症患者流行病学数据库中19个省市自治区22家三级甲等医院3 063例ICU患者的多中心前瞻性研究进行二次分析。收集入选患者的人口学资料、ICU相关评分、检验检查结果及医疗过程等。将所有患者分为单纯AKI（PAKI）和慢性肾脏病发展AKI（AoCKD）两型，PAKI是指符合KDIGO-AKI的血肌酐（SCr）标准（KDIGO-AKIn SCr）且基线估算肾小球滤过率（eGFR）≥60 mL·minn -1·1.73 mn -2；AoCKD是指符合KDIGO-AKIn SCr标准且基线eGFR为15～59 mL·minn -1·1.73 mn -2。以28 d内ICU全因病死率作为主要结局指标，ICU住院时间和肾脏替代治疗（RRT）比例作为次要结局指标。比较不同分型AKI患者基线资料和结局指标的差异；通过Kaplan-Meier生存曲线分析PAKI与AoCKD患者28 d内ICU累积存活率；采用Cox多因素分析筛选AKI患者28 d内ICU死亡的危险因素。n 结果:3 063例患者中最终有1 042例入选，其中AKI者345例，无AKI者697例，AKI发生率为33.11%；AKI患者28 d内ICU病死率为13.91%（48/345）。与PAKI患者（n n＝322）相比，AoCKD患者（n n＝23）年龄更大〔岁：74（59，77）比58（41，72）〕，基础肾功能更差〔eGFR（mL·minn -1·1.73 mn -2）：49（38，54）比115（94，136）〕，入ICU病情更危重〔急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ，分）：23（19，27）比15（11，22）〕，基础合并症更多〔查尔森合并症指数（CCI）：3（2，4）比0（0，1）〕，ICU住院期间SCr更高〔诊断AKI时SCr峰值（μmol/L）：412（280，515）比176（124，340），均n P<0.01〕；同时，AoCKD患者28 d内ICU病死率和RRT比例均明显高于PAKI患者〔39.13%（9/23）比12.11%（39/322），26.09%（6/23）比4.04%（13/322）〕，差异均有统计学意义（均n P<0.01）；然而AoCKD患者与PAKI患者的ICU住院时间比较差异则无统计学意义。Kaplan-Meier生存曲线分析结果显示，AoCKD患者28 d内ICU累积存活率明显低于PAKI患者（Log-Rank检验：n χ2＝5.939，n P＝0.015）。Cox多因素回归分析结果显示，因呼吸衰竭入ICU〔风险比（n HR）＝4.458，95%可信区间（95%n CI）为1.141～17.413，n P＝0.032〕、ICU内应用血管活性药物（n HR＝5.181，95%n CI为2.033～13.199，n P＝0.001）和KDIGO-AKIn SCr分型为AoCKD（n HR＝5.377，95%n CI为1.303～22.186，n P＝0.020）是AKI患者28 d内ICU死亡的独立危险因素。n 结论:基于KDIGO-AKIn SCr标准结合eGFR进一步细化分型（PAKI、AoCKD）与危重症患者28 d内ICU死亡有关。n “,”Objective:To investigate the different outcomes of two types of acute kidney injury (AKI) according to standard of Kidney Disease: Improving Global Outcomes-AKI (KDIGO-AKI), and to analyze the risk factors that affect the prognosis of intensive care unit (ICU) patients in China.Methods:A secondary analysis was performed on the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a multicenter prospective study involving 3 063 patients in 22 tertiary ICUs in 19 provinces and autonomous regions of China. The demographic data, scores reflecting severity of illness, laboratory findings, intervention during ICU stay were extracted. All patients were divided into pure AKI (PAKI) and acute on chronic kidney disease (AoCKD). PAKI was defined as meeting the serum creatinine (SCr) standard of KDIGO-AKI (KDIGO-AKIn SCr) and the estimated glomerular filtration rate (eGFR) at baseline was ≥ 60 mL·minn -1·1.73 mn -2, and AoCKD was defined as meeting the KDIGO-AKIn SCr standard and baseline eGFR was 15-59 mL·minn -1·1.73 mn -2. All-cause mortality in ICU within 28 days was the primary outcome, while the length of ICU stay and renal replacement therapy (RRT) were the secondary outcome. The differences in baseline data and outcomes between the two groups were compared. The cumulative survival rate of ICU within 28 days was analyzed by Kaplan-Meier survival curve, and the risk factors of ICU death within 28 days were screened by Cox multivariate analysis.n Results:Of the 3 063 patients, 1 042 were enrolled, 345 with AKI, 697 without AKI. The AKI incidence was 33.11%, while ICU mortality within 28 days of AKI patients was 13.91% (48/345). Compared with PAKI patients (n n = 322), AoCKD patients (n n = 23) were older [years old: 74 (59, 77) vs. 58 (41, 72)] and more critical when entering ICU [acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score: 23 (19, 27) vs. 15 (11, 22)], had worse basic renal function [eGFR (mL·minn -1·1.73 mn -2): 49 (38, 54) vs. 115 (94, 136)], more basic complications [Charlson comorbidity index (CCI): 3 (2, 4) vs. 0 (0, 1)] and higher SCr during ICU stay [peak SCr for diagnosis of AKI (μmol/L): 412 (280, 515) vs. 176 (124, 340), alln P < 0.01]. The mortality and RRT incidence within 28 days in ICU of AoCKD patients were significantly higher than those of PAKI patients [39.13% (9/23) vs. 12.11% (39/322), 26.09% (6/23) vs. 4.04% (13/322), both n P < 0.01], while no significant difference was found in the length of ICU stay. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate in ICU in AoCKD patients was significantly lower than PAKI patients (Log-Rank: n χ2 = 5.939, n P = 0.015). Multivariate Cox regression analysis showed that admission to ICU due to respiratory failure [hazard ratio (n HR) = 4.458, 95% confidence interval (95%n CI) was 1.141-17.413, n P = 0.032], vasoactive agents treatment in ICU (n HR = 5.181, 95%n CI was 2.033-13.199, n P = 0.001), and AoCKD (n HR = 5.377, 95%n CI was 1.303-22.186, n P = 0.020) were independent risk factors for ICU death within 28 days.n Conclusion:Further detailed classification (PAKI, AoCKD) based on KDIGO-AKIn SCr standard combined with eGFR is related to ICU mortality in critical patients within 28 days.n