The benefit of specialized team approaches in patients with acute kidney injury undergoing continuous renal replacement therapy: propensity score matched analysis
The benefit of specialized team approaches in patients with acute kidney injury undergoing continuous renal replacement therapy: propensity score matched analysis
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DOI：
10.1186/s13054-014-0454-8
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发表时间：
2014-01-01
期刊：
影响因子：
15.1
通讯作者：
Yoo, Tae-Hyun
中科院分区：
文献类型：
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作者：
Oh, Hyung Jung;Lee, Mi Jung;Yoo, Tae-Hyun
简介：连续性肾脏替代治疗（CRRT）已广泛应用于危重急性肾损伤（AKI）患者。此外，一些中心还设有由医生和护士组成的专业CRRT团队（SCT），但很少有研究确定SCT控制的优越性。 方法：将2007年8月至2009年9月在延世大学医疗系统因严重AKI开始CRRT并与倾向评分（PS）相匹配的534名原始队列患者中的334名患者根据SCT应用分为两组。此外，我们还比较了 CRRT 相关结果，包括两组之间每天的停机时间和每次过滤器更换损失的时间。主要终点为28天和90天全因死亡率，次要终点为28天和90天肾功能恢复率。 结果：与SCT前组相比，CRRT治疗期间每日停机时间、每次滤器更换损失时间和红细胞输注数量显着降低，而SCT后组的净超滤率显着高于SCT前组。研究期间，应用SCT后28天和90天全因死亡率显着降低。 Cox 回归分析显示，在调整初步诊断、紧急手术病例、查尔森合并症指数和生化参数后，SCT 控制下的 28 天和 90 天全因死亡率显着降低。然而，CRRT 中 SCT 方法前后的肾功能恢复率没有显着差异。结论：组织良好的 CRRT 团队可以通过提高需要在 ICU 进行 CRRT 治疗的 AKI 患者的护理质量来有益于临床结果。
Introduction: Continuous renal replacement therapy (CRRT) has been widely used in critically ill acute kidney injury (AKI) patients. Moreover, some centers operate a specialized CRRT team (SCT) composed of physicians and nurses, but few studies have yet determined the superiority of SCT control.Methods: A total of 334 among 534 patients in the original cohort, who started CRRT for severe AKI between August 2007 and September 2009 in Yonsei University Health System and were matched with a propensity score (PS), were divided into two groups based on SCT application. Moreover, we compared CRRT-related outcomes including down-time per day and lost time per filter-exchange between the two groups. The primary outcomes were 28- and 90-day all-cause mortality, and the secondary outcomes were the rates of renal function recovery at 28- and 90-day.Results: The down-time per day, lost time per filter-exchange, and red blood cell-transfused numbers during CRRT treatment were significantly lower after SCT approach compared with the group before SCT, while net ultrafiltration rate in the after SCT group was significantly higher compared to the before SCT group. During the study period, the 28- and 90-day all-cause mortality rates were significantly decreased after SCT application. Cox regression analysis revealed that 28- and 90-day all-cause mortality rates were significantly lower under SCT control, after adjusting for primary diagnosis, emergent surgical cases, Charlson Comorbidity Index and biochemical parameters. However, there were no significant differences in the rate of renal function recovery before and after SCT approach in CRRT.Conclusions: A well-organized CRRT team could be beneficial for clinical outcomes through improving quality of care in AKI patients requiring CRRT treatment in the ICU.