Acute Kidney Injury and Risk of Adverse Neurocognitive Outcomes: A Systematic Review and Meta-Analysis.

We conducted a systematic reviewand meta-analysisto evaluate associations between AKI and subsequent risk of stroke, delirium, and dementia.

我们进行了一项系统评价和荟萃分析，以评估AKI与随后中风、谵妄和痴呆风险之间的关联。

Methods

Eligible studies were identified by searching Ovid MEDLINE and Embase from inception (Ovid: January 1946; Embase: January 1970) until April 2025.

通过检索Ovid MEDLINE和Embase数据库，从创建之初（Ovid: 1946年1月; Embase: 1970年1月）至2025年4月，确定了符合条件的研究。

Studies were included if they reported quantitative estimates with measures of precision for the association between AKI and delirium, stroke, or dementia in adult populations.

如果研究报道了成人AKI与谵妄、中风或痴呆之间关联的定量估计及其精确度测量，则被纳入研究。

Two reviewers independently screened and extracted data, and study quality was assessed using standardized criteria.

两位评审员独立进行筛选和数据提取，使用标准化标准评估研究质量。

Study characteristics, participant demographics, and adjusted effect estimates (hazard ratios [HRs] or odds ratios [ORs]) with 95% CIs were extracted.

提取了研究特征、参与者人口统计学特征以及调整后的效应估计值（风险比[HRs]或比值比[ORs]）及其95%置信区间。

Pooled HRs and ORs with 95% CIs were calculated using random-effects models.

使用随机效应模型计算了汇总的危险比（HRs）和优势比（ORs）及其95%置信区间（CIs）。

Heterogeneity was evaluated with the χ2 test and I2 statistic, and sources of heterogeneity were explored through prespecified subgroup analyses and meta-regression.

通过卡方检验和I2统计量评估了异质性，并通过预先设定的亚组分析和元回归探索了异质性的来源。

Results

We identified 49 studies comprising 11,253,825 participants with 1,279,145 events.

我们确定了49项研究，涵盖了11,253,825名参与者和1,279,145起事件。

Individuals with AKI were at increased risk of stroke (pooled adjusted HR 1.35, 95% CI 1.20-1.52), delirium (pooled adjusted OR 1.76; 1.42-2.17), and dementia (pooled adjusted HR 1.64, 1.41-1.89).

患有急性肾损伤（AKI）的个体中风风险增加（汇总调整后的风险比为1.35，95%置信区间为1.20-1.52），谵妄风险增加（汇总调整后的比值比为1.76；95%置信区间为1.42-2.17），以及痴呆风险增加（汇总调整后的风险比为1.64，95%置信区间为1.41-1.89）。

A gradient of risk across increasing AKI stages was demonstrated for stroke (stage 1: HR 1.11; 1.00-1.23; combined stages 2 and 3: HR 1.57; 1.35-1.81).

在增加的急性肾损伤（AKI）阶段中，对于中风显示出风险梯度（1期：风险比（HR）1.11；95%置信区间（CI）1.00-1.23；2期和3期合并：HR 1.57；95% CI 1.35-1.81）。

AKI was also associated with higher in-hospital and 90-day mortality poststroke (pooled HR 2.13, 1.56-2.90, and 4.81, 2.55-9.08, respectively) and with 90-day disability (pooled adjusted OR 1.47, 1.22-1.76).

AKI还与中风后的住院和90天死亡率较高相关（合并HR分别为2.13，95% CI 1.56-2.90和4.81，95% CI 2.55-9.08），以及与90天残疾相关（合并调整后的比值比（OR）为1.47，95% CI 1.22-1.76）。

Associations between AKI and all outcomes were directionally consistent across sensitivity analyses and pooled propensity score-matched studies.

在敏感性分析和倾向得分匹配研究的汇总中，急性肾损伤（AKI）与所有结果之间的关联方向一致。

Discussion

In this systematic reviewand meta-analysis, AKI was consistently associated with increased short-term and long-term neurocognitive risk, including stroke, delirium, and dementia.

在这项系统评价和荟萃分析中，AKI 与短期和长期的神经认知风险增加一致相关，包括中风、谵妄和痴呆。

These findings suggest that AKI may identify individuals vulnerable to both acute and chronic brain injury.

这些发现表明，急性肾损伤（AKI）可能识别出对急性及慢性脑损伤都易感的个体。

Further studies are needed to clarify mechanisms linking AKI to brain injury and to identify strategies to mitigate neurocognitive risk in this high-risk population.

需要进一步的研究来阐明急性肾损伤（AKI）与脑损伤之间的联系机制，并确定减轻这一高风险人群神经认知风险的策略。