Oliguria as predictive biomarker of acute kidney injury in critically ill patients.
Oliguria as predictive biomarker of acute kidney injury in critically ill patients.
复制标题
DOI：
10.1186/cc10318
复制
发表时间：
2011-07-19
期刊：
影响因子：
--
通讯作者：
Bellomo R
中科院分区：
文献类型：
--
作者：
Prowle JR;Liu YL;Licari E;Bagshaw SM;Egi M;Haase M;Haase-Fielitz A;Kellum JA;Cruz D;Ronco C;Tsutsui K;Uchino S;Bellomo R
在危重病期间，少尿常被用作急性肾损伤（阿基）的生物标志物。然而，其与阿基后续发展的关系尚未进行前瞻性评估。我们记录了来自六个国家的七个重症监护室（ICU）在两到四周内住院超过24小时的患者的尿量和每日血清肌酐浓度。少尿定义为尿量< 0.5 ml/kg/hr。收集数据，直至发生肌酐定义的阿基（AKI-Cr），使用肌酐标准（RIFLE-I [Cr]）指定为RIFLE-损伤级别或更高级别，或直至ICU出院。根据每天连续少尿的最长持续时间对少尿发作进行分类，并与第二天新的AKI-Cr相关，检查持续时间大于1、2、3、4、5、6或12小时的少尿的截止值。我们在723天内研究了239例患者。总体而言，32例患者在ICU入院时发生阿基，而23例患者在ICU发生AKI-Cr。少尿超过1小时与第二天的AKI-Cr显著相关。在接受者-操作者特征曲线下面积（ROCAUC）分析中，少尿显示出对AKI-Cr的良好预测能力（ROCAUC = 0. 75; CI：0. 64 - 0. 85）。4小时或以上少尿的存在提供了最好的区分（敏感性52%（0.31-0.73%），特异性86%（0.84-0.89%），阳性似然比3.8（2.2-5.6），P < 0.0001），阴性预测值为98%（0.97-0.99）。AKI-Cr前少尿更可能与血压降低、心率加快和使用血管加压药或正性肌力药相关，更可能提示临床干预。然而，在487例少尿患者中，只有30例在第二天新发生AKI-Cr之前发生。少尿与新发AKI-Cr的发生显著相关，然而，与ICU中发生AKI-Cr的少数患者（约10%）相比，少尿发生频率较高，因此大多数少尿事件不会继发肾损伤。因此，短时间（1-6小时）少尿的发生在区分具有初期AKI-Cr的患者方面缺乏实用性（阳性似然比为2-4，其中> 10被认为指示有用的筛选测试）。然而，少尿伴随血流动力学损害或血管加压药剂量增加可能代表其他肾损伤早期生物标志物的临床有用的触发因素。
During critical illness, oliguria is often used as a biomarker of acute kidney injury (AKI). However, its relationship with the subsequent development of AKI has not been prospectively evaluated. We documented urine output and daily serum creatinine concentration in patients admitted for more than 24 hours in seven intensive care units (ICUs) from six countries over a period of two to four weeks. Oliguria was defined by a urine output < 0.5 ml/kg/hr. Data were collected until the occurrence of creatinine-defined AKI (AKI-Cr), designated by RIFLE-Injury class or greater using creatinine criteria (RIFLE-I[Cr]), or until ICU discharge. Episodes of oliguria were classified by longest duration of consecutive oliguria during each day were correlated with new AKI-Cr the next day, examining cut-offs for oliguria of greater than 1,2,3,4,5,6, or 12 hr duration, We studied 239 patients during 723 days. Overall, 32 patients had AKI on ICU admission, while in 23, AKI-Cr developed in ICU. Oliguria of greater than one hour was significantly associated with AKI-Cr the next day. On receiver-operator characteristic area under the curve (ROCAUC) analysis, oliguria showed fair predictive ability for AKI-Cr (ROCAUC = 0.75; CI:0.64-0.85). The presence of 4 hrs or more oliguria provided the best discrimination (sensitivity 52% (0.31-0.73%), specificity 86% (0.84-0.89%), positive likelihood ratio 3.8 (2.2-5.6), P < 0.0001) with negative predictive value of 98% (0.97-0.99). Oliguria preceding AKI-Cr was more likely to be associated with lower blood pressure, higher heart rate and use of vasopressors or inotropes and was more likely to prompt clinical intervention. However, only 30 of 487 individual episodes of oliguria preceded the new occurrence of AKI-Cr the next day. Oliguria was significantly associated with the occurrence of new AKI-Cr, however oliguria occurred frequently compared to the small number of patients (~10%) developing AKI-Cr in the ICU, so that most episodes of oliguria were not followed by renal injury. Consequently, the occurrence of short periods (1-6 hr) of oliguria lacked utility in discriminating patients with incipient AKI-Cr (positive likelihood ratios of 2-4, with > 10 considered indicative of a useful screening test). However, oliguria accompanied by hemodynamic compromise or increasing vasopressor dose may represent a clinically useful trigger for other early biomarkers of renal injury.
登录
查看更多内容
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：
158.5
作者：
ANDERSON, RJ;LINAS, SL;SCHRIER, RW
通讯作者：
SCHRIER, RW
影响因子：
6.1
作者：
Bagshaw, Sean M.;Uchino, Shigehiko;Kellum, John A.
通讯作者：
Kellum, John A.
DOI：
10.1016/j.ejvs.2007.03.010
发表时间：
2007-11-01
影响因子：
5.7
作者：
McArdle, G. T.;Price, G.;Harkin, D. W.
通讯作者：
Harkin, D. W.
影响因子：
120.7
作者：
LEGALL, JR;LEMESHOW, S;SAULNIER, F
通讯作者：
SAULNIER, F