inical characteristics and mortality risks.The study underscores the necessity of age-specific AKI management strategies, informed by diverse etiologies and survival outcomes across the lifespan. Background AKI is a complex syndrome typically classified into strict categories. Alternatively, it may be more accurate to consider it as an intermediate event between an initiating cause and its outcome. Therefore, we investigated the burden of clinical scenarios associated with dialysis-requiring AKI using latent class analysis (LCA) and examined the etiological spectrum and clinical phenotypes across different life stages. Methods We analyzed 17,158 patients with dialysis-requiring AKI from 170 medical facilities in Rio de Janeiro, Brazil (2002–2012). Using survival curves and mixed-effects Cox regression for survival estimation, LCA classified patients on the basis of clinical characteristics and outcomes, focusing on etiological variation over the human lifespan. Results The median age was 75 years (interquartile range, 59–83). Infections were the most common cause (44.2%), particularly community-acquired pneumonia (23.8%). Cardiovascular issues, especially ischemic heart disease (9.0%) and acute heart failure (8.1%), were also significant. LCA identified four distinct patient classes with varying clinical and outcome profiles. Class 1 patients were younger (median age, 66 years), predominantly male, with lower intensive care unit admission rates and higher rates of community-acquired AKI (60.8%). They had the lowest mortality (39.5%) and highest recovery rates. Class 2 had intermediate mortality (67.4%) and the highest comorbidity burden (mean Charlson score, 3.39). Classes 3 and 4 had the highest mortality (82.8% and 78.6%, respectively), requiring more mechanical ventilation and vasopressor use. Class 3 had a high prevalence of sepsis (92.7%) with lower comorbidities while class 4 had high chronic heart disease (76.3%) and perfusion factors (79.4%). Despite high mortality, class 3 patients recovered better than class 2 and 4 patients. Survival analyses revealed diverse outcomes across etiological groups, with liver-related conditions being the most severe. Conclusions This study highlights the complexity of AKI and utility of LCA in revealing its clinical heterogeneity. It underscores distinct etiological trends across ages, suggesting future research should integrate clinical profiles with advanced diagnostics to understand AKI's clinical and molecular phenotypes throughout life....

中文翻译：

---

南美人群需要透析的急性肾损伤的表型及其与死亡率的相关性


初始特征和死亡风险。该研究强调了针对特定年龄的 AKI 管理策略的必要性，该策略以整个生命周期的不同病因和生存结果为依据。背景 AKI 是一种复杂的综合征，通常分为严格的类别。或者，将其视为起始原因与其结果之间的中间事件可能更准确。因此，我们使用潜在类别分析 （LCA） 调查了与需要透析的 AKI 相关的临床情景的负担，并检查了不同生命阶段的病因谱和临床表型。方法 我们分析了来自巴西里约热内卢 170 家医疗机构的 17,158 名需要透析的 AKI 患者 （2002-2012）。使用生存曲线和混合效应 Cox 回归进行生存估计，LCA 根据临床特征和结果对患者进行分类，重点关注人类一生中的病因学变化。结果 中位年龄为 75 岁 （四分位距，59-83）。感染是最常见的原因 （44.2%），尤其是社区获得性肺炎 （23.8%）。心血管问题，尤其是缺血性心脏病 （9.0%） 和急性心力衰竭 （8.1%），也很严重。LCA 确定了四种不同的患者类别，具有不同的临床和结果特征。1 级患者较年轻 （中位年龄 66 岁），以男性为主，重症监护病房入院率较低，社区获得性 AKI 发生率较高 （60.8%）。他们的死亡率最低 （39.5%） 和最高康复率。2 级死亡率中等 （67.4%） 和最高的合并症负担 （平均 Charlson 评分，3.39）。第 3 类和第 4 类患者的死亡率最高（分别为 82.8% 和 78%。6%），需要更多的机械通气和血管加压药的使用。3 类脓毒症患病率高 （92.7%），合并症较低，而 4 类慢性心脏病 （76.3%） 和灌注因子 （79.4%） 高。尽管死亡率高，但 3 级患者的恢复效果优于 2 级和 4 级患者。生存分析揭示了不同病因组的不同结果，其中肝脏相关疾病最为严重。结论 本研究强调了 AKI 的复杂性和 LCA 在揭示其临床异质性方面的效用。它强调了不同年龄段的不同病因学趋势，建议未来的研究应将临床概况与高级诊断相结合，以了解 AKI 一生中的临床和分子表型。