目的本研究旨在评价血清前白蛋白对住院期间发生急性肾小管损伤坏死(acute tubular necrosis)所致急性肾损伤(acute kidney injury, AKI)患者的预后影响。方法本研究前瞻性入选自2012 年02 月至2014 年06 月在上海交通大学医学院附属第九人民医院住院期间发生急性肾损伤患者。采用Cox 比例风险模型来评估血清前白蛋白与急性肾损伤患者90 天死亡风险的关系。结果本研究共入选住院期间急性肾损伤患者348 例，根据全体患者血清前白蛋白的中位数，分为低血清白蛋白组(＜13.6mg/dl 组)和高血清白蛋白组(≥13.6mg/dl 组)，低血清前白蛋白组90 天死亡率为48.3%，而高血清前白蛋白组为21.4%(χ2 =13.622,P＜0.001)。在校正了年龄、性别、C 反应蛋白水平、血清白蛋白、血红蛋白、Liano 评分和胆固醇后，Cox 比例风险模型显示，低血清前白蛋白组住院AKI 患者的90 天全因死亡的风险比(Harazd ratio,HR)为1.784(95% CI 1.059～3.006, P=0.029)。并且每增加5mg/dl 血清前白蛋白，90 天死亡率降低24.6%(HR 0.754，95% CI 0.606～0.938，P =0.011)。结论血清前白蛋白是住院期间发生AKI患者全因死亡的独立危险因素。

Objective To evaluated the prognostic value of prealbumin levels in patients with acute kidney injury (AKI)，which reason for causing AKI is acute tubular necrosis. Methods This was a prospective cohort study. Hospital- acquired AKI patients in the Ninth People’s Hospital from February 2012 to June 2014. laboratory measurements and clinical data were recorded. Cox proportional hazards models was uesd to estimate the risk of the ninety days mortality associated with serum prealbumin level at the beginning of the nephrology consultation. Results Three hundreds and forty-eight hospital-acquired AKI patients matched at least one of the Risk, Injury, Failure, Loss, End Stage (RIFLE) criteria for increased serum creatinine, and had requested a nephrology consultation. Clinicopathologic variables were compared between patients with a serum prealbumin level, ＜13.6 mg/dL (the exposed group; cutoff point, median) and patients with a serum prealbumin level≥13.6 mg/dL (the control group). In-hospital mortality rates associated with prealbumin levels were 48.3% for ＜13.6 mg/dL, and 21.4% for≥13.6mg/dL (χ2=13.622, P＜0.001). After adjusted analysis age, sex, hemoglobin, serum albumin, C-reactive protein, Liano score and serum total cholesterol, the presence of a serum prealbumin level, ＜13.6mg/dL was significantly associated with increased the ninety days mortality (HR 1.784，95% confidence interval 1.059～3.006, P = 0.029). In addition, each increment of 5 mg/dL of serum prealbumin was associated with an adjusted 24% decrease of the ninety days mortality (HR 0.754，95% confidence interval 0.606～0.938，P=0.011). Conclusions Low levels of serum prealbumin was an independent risk factor of death in hospital-acquired AKI patients