Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury.
Impact of timing of renal replacement therapy initiation on outcome of septic acute kidney injury.
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DOI：
10.1186/cc10252
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
NSARF Study Group
中科院分区：
文献类型：
--
作者：
Chou YH;Huang TM;Wu VC;Wang CY;Shiao CC;Lai CF;Tsai HB;Chao CT;Young GH;Wang WJ;Kao TW;Lin SL;Han YY;Chou A;Lin TH;Yang YW;Chen YM;Tsai PR;Lin YF;Huang JW;Chiang WC;Chou NK;Ko WJ;Wu KD;Tsai TJ;NSARF Study Group
脓毒症是危重患者急性肾损伤(AKI)的主要原因。败血症AKI患者启动肾脏替代治疗(RRT)的最佳时机仍然存在争议。本研究的目的是根据简化的RIFLE(风险、损伤、衰竭、肾功能丧失和终末期肾功能衰竭)分类(SRIFLE)，确定早期或晚期启动RRT对败血症AKI患者住院死亡率的影响。研究对象为2002年1月至2009年10月在外科重症监护病房接受RRT治疗的脓毒症和AKI患者。根据sRIFLE标准将患者分为早期(sRIFLE-0或-Risk)和晚期(sRIFLE-损伤或失败)启动RRT。确定住院死亡率的Cox比例风险比，以评估RRT时机的影响。在370例患者中，192例(51.9%)接受了早期RRT，259例(70.0%)在住院期间死亡。早期RRT组和晚期RRT组死亡率分别为70.8%和69.7%(P>；0.05)。通过Cox比例风险模型分析，早期透析与住院死亡率无关(P>；0.05)。有心力衰竭、男性、入院肌酐较高和手术的患者更有可能属于晚期RRT组。COX比例风险模型在根据晚期RRT的概率调整了包括所有患者在内的倾向评分后，显示早期透析与住院死亡率无关。根据每个患者的晚期RRT倾向，进一步的模型以1：1的方式匹配患者，根据人口统计学数据的逐头比较显示，住院死亡率没有差异(P>；0.05)。在感染性AKI中，使用sRIFLE分类作为标记很难预测早期或晚期RRT的益处。在未来，应该确定更多具有生理意义的标记，用来确定RRT的最佳启动时间。
Sepsis is the leading cause of acute kidney injury (AKI) in critical patients. The optimal timing of initiating renal replacement therapy (RRT) in septic AKI patients remains controversial. The objective of this study is to determine the impact of early or late initiation of RRT, as defined using the simplified RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal failure) classification (sRIFLE), on hospital mortality among septic AKI patients. Patient with sepsis and AKI requiring RRT in surgical intensive care units were enrolled between January 2002 and October 2009. The patients were divided into early (sRIFLE-0 or -Risk) or late (sRIFLE-Injury or -Failure) initiation of RRT by sRIFLE criteria. Cox proportional hazard ratios for in hospital mortality were determined to assess the impact of timing of RRT. Among the 370 patients, 192 (51.9%) underwent early RRT and 259 (70.0%) died during hospitalization. The mortality rate in early and late RRT groups were 70.8% and 69.7% respectively (P > 0.05). Early dialysis did not relate to hospital mortality by Cox proportional hazard model (P > 0.05). Patients with heart failure, male gender, higher admission creatinine, and operation were more likely to be in the late RRT group. Cox proportional hazard model, after adjustment with propensity score including all patients based on the probability of late RRT, showed early dialysis was not related to hospital mortality. Further model matched patients by 1:1 fashion according to each patient's propensity to late RRT showed no differences in hospital mortality according to head-to-head comparison of demographic data (P > 0.05). Use of sRIFLE classification as a marker poorly predicted the benefits of early or late RRT in the context of septic AKI. In the future, more physiologically meaningful markers with which to determine the optimal timing of RRT initiation should be identified.
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影响因子：
38.9
作者：
de Mendonça, A;Vincent, JL;Cantraine, F
通讯作者：
Cantraine, F
影响因子：
19.6
作者：
Bouchard, Josee;Soroko, Sharon B.;Mehta, Ravindra L.
通讯作者：
Mehta, Ravindra L.
影响因子：
13.6
作者：
Huang, Tao-Min;Wu, Vin-Cent;Wu, Kwan-Dun
通讯作者：
Wu, Kwan-Dun
影响因子：
3.4
作者：
Elahi, MM;Lim, MY;Spyt, TJ
通讯作者：
Spyt, TJ
影响因子：
8.8
作者：
Levy, MM;Fink, MP;Ramsay, G
通讯作者：
Ramsay, G