背景：急性腎損傷的定義是血清肌酸酐濃度與基準值相比，上升0.3mg/dL。國外有研究利用醫院基礎的資料、大型登錄資料庫、或行政資料庫探討接受冠狀動脈介入治療病人之急性腎損傷，然而其估計之急性腎損傷發生率會隨著不同的研究族群及不同的定義而有差異。而利用行政資料庫探討急性腎損傷發生率的研究，其結果會受編碼正確性的影響，台灣健保資料庫亦有同樣的問題。
目的：本研究之目的有二，一是利用醫院之病歷資料，探討病人接受冠狀動脈介入治療後急性腎損傷之發生率、預測因子、與病人的預後，二是探討健保申報資料之診斷碼對於識別病人是否發生急性腎損傷之準確率。
方法：本研究分為二個部分，資料來源是南部某醫學中心之病歷資料，研究對象為2012年7月1日到2015年12月31日間，住院接受冠狀動脈介入治療之病人。第一部分是用病歷回顧的方式，以病人接受冠狀動脈介入治療前14天內最近一次的血清肌酸酐濃度當作基準值，若病人在接受冠狀動脈介入治療後14天內之血清肌酸酐濃度上升大於0.3mg/dL，則診斷為有發生急性腎損傷，並參考急性腎損傷照護網之診斷準則，將急性腎損傷之嚴重度分為第1、2、3期，此外若病人因急性腎損傷而需接受透析治療，代表其急性腎損傷的嚴重度最高，定義為需接受透析治療之急性腎損傷，本研究會探討冠狀動脈介入治療後各期別急性腎損傷及需接受透析治療之急性腎損傷的發生率。第二部分是探討健保申報資料之國際疾病分類第九版臨床修訂(International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM)診斷碼對於識別病人是否發生急性腎損傷之準確率，以血清肌酸酐濃度之前後變化作為診斷病人是否發生急性腎損傷之黃金準則，比對該筆住院健保申報資料之診斷欄位中，是否有急性腎損傷之相關診斷碼，藉此判斷健保申報資料之診斷碼對於識別病人是否發生急性腎損傷之準確率。
結果：本研究共納入1,204位接受冠狀動脈介入治療之病人，其中發生急性腎損傷者共201人，發生率為16.7%；第1、2、3期急性腎損傷及需接受透析治療之急性腎損傷的發生率分別是9.0%、1.1%、2.2%、及4.4%。發生急性腎損傷及需接受透析治療之急性腎損傷的危險因子包括基準腎功能較差、急性心肌梗塞、發生心因性休克、以及接受主動脈內氣球幫浦等。此外發生各期別急性腎損傷者之死亡風險皆高於未發生急性腎損傷者。發生急性腎損傷的201位病人中，健保申報資料有急性腎損傷之ICD-9-CM診斷碼584者只有45位，健保申報資料識別病人是否發生急性腎損傷之敏感度為22.39%。年紀較大者(≥55歲)健保申報資料之敏感度較年紀輕(<55歲)者低(19.34% vs 50%, p=0.002)；以性別分層，健保申報資料之敏感度在男女性無差異，約為22%。若以較嚴格之急性腎損傷診斷準則當作黃金標準，在第2期以上之急性腎損傷、第3期急性腎損傷、及需接受透析治療之急性腎損傷者，健保申報資料識別病人是否發生急性腎損傷之敏感度會隨之升高，分別是38.71%、45.00%、及47.17%。發生第2期以上之急性腎損傷者共93人，其中有42位病人未被下急性腎損傷之診斷，underdiagnosis的比例為45.16%。
結論：冠狀動脈介入治療之病人急性腎損傷及需接受透析治療之急性腎損傷發生率分別16.7%及4.4%，各期別嚴重程度的急性腎損傷都是住院中死亡的獨立危險因子。健保申報資料中，急性腎損傷之ICD-9-CM診斷碼584對於識別病人是否發生急性腎損傷之敏感度只有22.39%，因此若想用健保申報資料做冠狀動脈介入治療相關急性腎損傷之研究，須注意此問題。

INTRODUCTION: Acute kidney injury (AKI) is a complication of percutaneous coronary intervention (PCI). However, the incidences varied with populations and definitions of AKI. The purpose of this study was to examine the incidence, predictors, and outcome of AKI in PCI patients, and explored the validity of AKI diagnoses in claims data.
METHODS: We retrospectively reviewed the medical records of 1,204 patients undergoing PCIs at a tertiary care center. AKI was defined in accordance with the definition of Acute Kidney Injury Network (AKIN) criteria; dialysis-requiring AKI (AKI-D) was defined as initiation of new dialysis after PCI. We also identified the risk factors associated with the development of AKI and AKI-D and the association between AKI and patient outcomes.
RESULTS: The incidence of stage 1, 2, 3 AKI and AKI-D were 9.0%, 1.1%, 2.2%, and 4.4%, respectively. The risk factors associated with development of AKI and AKI-D included poorer baseline kidney function, cardiogenic shock, and intra-aortic balloon pump (IABP) insertion. The mean length of stay was 6.77 days and AKI is associated with longer length of stay. AKI and AKI-D were independent predictors of in-hospital mortality. ICD-9-CM codes for AKI in claims data had a sensitivity of 22.39%, specificity of 98.01%, PPV of 69.23%, and NPV of 86.30%.
CONCLUSION: We found that AKI developed in 16.7% of patients, 4.4% of whom required acute dialysis. Baseline renal function markedly increased the risk of the development of AKI or AKI-D. Patients with AKI or AKI-D experienced high risk of in-hospital mortality. Identifying AKI in PCI patients using administrative diagnostic codes will result in an underestimation of the true incidence.

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