Fluid overload is associated with an increased risk for 90-day mortality in critically ill patients with renal replacement therapy: data from the prospective FINNAKI study.
Fluid overload is associated with an increased risk for 90-day mortality in critically ill patients with renal replacement therapy: data from the prospective FINNAKI study.
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DOI：
10.1186/cc11682
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发表时间：
2012-10-17
期刊：
影响因子：
--
通讯作者：
FINNAKI Study Group
中科院分区：
文献类型：
--
作者：
Vaara ST;Korhonen AM;Kaukonen KM;Nisula S;Inkinen O;Hoppu S;Laurila JJ;Mildh L;Reinikainen M;Lund V;Parviainen I;Pettilä V;FINNAKI Study Group
无论是否接受肾脏替代治疗(RRT)，液体正平衡都会增加急性肾损伤危重患者的死亡风险。关于RRT开始前体液蓄积和死亡率的数据有限。我们的目的是研究RRT开始时液体堆积与90天死亡率之间的关系。我们在五个月的时间里对17个芬兰重症监护病房(ICU)进行了一项前瞻性、多中心、观察性队列研究。我们收集了关于患者特征、RRT时机和RRT开始时的参数的数据。我们研究了RRT开始时的参数，包括液体超载(定义为累积液体累积&基线体重的10%)与90天死亡率的关系。我们纳入了296名接受RRT治疗的危重患者。在283例有完整的液体平衡数据的患者中，76例(26.9%)患者有液体超负荷。从ICU入院到RRT开始的中位时间(四分位数范围)为14(3.3~41.5)小时。整个队列的90天死亡率为296人中的116人(39.2%；95%可信区间38.6-39.8%)。无论有无液体超载，患者90天的粗死亡率分别为45/76(59.2%)和65/207(31.4%)，P<；0.001。在Logistic回归分析中，在调整了疾病严重程度、RRT开始时间、初始RRT方式和脓毒症后，液体超负荷与90天死亡率增加相关(优势比2.6)。在168名有90天RRT使用数据的幸存者中，34人(18.9%，95%可信区间13.2~24.6%)仍然依赖RRT。在RRT开始时有液体超载的患者的90天粗死亡率是无RRT患者的两倍。液体超载与90天死亡率增加相关，即使在调整后也是如此。
Positive fluid balance has been associated with an increased risk for mortality in critically ill patients with acute kidney injury with or without renal replacement therapy (RRT). Data on fluid accumulation prior to RRT initiation and mortality are limited. We aimed to study the association between fluid accumulation at RRT initiation and 90-day mortality. We conducted a prospective, multicenter, observational cohort study in 17 Finnish intensive care units (ICUs) during a five-month period. We collected data on patient characteristics, RRT timing, and parameters at RRT initiation. We studied the association of parameters at RRT initiation, including fluid overload (defined as cumulative fluid accumulation > 10% of baseline weight) with 90-day mortality. We included 296 RRT-treated critically ill patients. Of 283 patients with complete data on fluid balance, 76 (26.9%) patients had fluid overload. The median (interquartile range) time from ICU admission to RRT initiation was 14 (3.3 to 41.5) hours. The 90-day mortality rate of the whole cohort was 116 of 296 (39.2%; 95% confidence interval 38.6 to 39.8%). The crude 90-day mortality of patients with or without fluid overload was 45 of 76 (59.2%) vs. 65 of 207 (31.4%), P < 0.001. In logistic regression, fluid overload was associated with an increased risk for 90-day mortality (odds ratio 2.6) after adjusting for disease severity, time of RRT initiation, initial RRT modality, and sepsis. Of the 168 survivors with data on RRT use at 90 days, 34 (18.9%, 95% CI 13.2 to 24.6%) were still dependent on RRT. Patients with fluid overload at RRT initiation had twice as high crude 90-day mortality compared to those without. Fluid overload was associated with increased risk for 90-day mortality even after adjustments.
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DOI：
10.1186/cc10061
发表时间：
2011
期刊：
Critical care (London, England)
影响因子：
--
作者：
Karvellas CJ;Farhat MR;Sajjad I;Mogensen SS;Leung AA;Wald R;Bagshaw SM
通讯作者：
Bagshaw SM
影响因子：
6.1
作者：
Heung, Michael;Wolfgram, Dawn F.;Ojo, Akinlolu O.
通讯作者：
Ojo, Akinlolu O.
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：
19.6
作者：
Goldstein, SL;Somers, MJG;Fortenberry, JD
通讯作者：
Fortenberry, JD
影响因子：
4.2
作者：
Fulop, Tibor;Pathak, Minesh B.;Juncos, Luis A.
通讯作者：
Juncos, Luis A.