Association between Latent Trajectories of Fluid Balance and Clinical Outcomes in Critically Ill Patients with Acute Kidney Injury: A Prospective Multicenter Observational Study
Association between Latent Trajectories of Fluid Balance and Clinical Outcomes in Critically Ill Patients with Acute Kidney Injury: A Prospective Multicenter Observational Study
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DOI：
10.1159/000515533
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发表时间：
2021-07
期刊：
影响因子：
3.7
通讯作者：
Meiping Wang;B. Zhu;Li Jiang;Xuying Luo;Na Wang;Yibing Zhu;X. Xi
中科院分区：
文献类型：
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作者：
Meiping Wang;B. Zhu;Li Jiang;Xuying Luo;Na Wang;Yibing Zhu;X. Xi
前言：我们的目的是确定不同的液体平衡轨迹，并研究液体平衡轨迹对重症监护病房(ICU)急性肾损伤(AKI)患者临床结局的影响，以及液体过载(FO)与死亡率之间的剂量-反应关系。方法：数据来源于北京急性肾损伤试验(BAKIT)。共有1,529名AKI危重患者纳入研究。主要结果是28天的死亡率，住院死亡率、ICU死亡率和AKI分期是次要结果。使用基于组的轨迹模型来识别FB在前7天的轨迹。采用多变量Logistic回归分析FB轨迹与临床结果之间的关系。使用限制三次样条法的Logistic回归模型检验了FO与28天死亡率之间的剂量关系。结果：Fb轨迹分为三种：低Fb(1,316，86.1%)、降低Fb(120，7.8%)和高Fb(93，6.1%)。与低Fb组相比，高Fb组患者28天死亡率(优势比[OR]1.94，95%可信区间[CI]1.17-3.19)和AKI分期增加(OR 2.04，95%CI 1.23-3.37)，而低Fb组患者28天死亡率降低约一半(OR 0.53，95%CI 0.32-0.87)。ICU死亡率和住院死亡率的结果也发现了类似的结果。我们观察到最大FO与28天死亡率之间呈J型关系，当最大FO为2.8%L/公斤时，风险最低。结论：AKI危重病患者不同的Fb运动轨迹与临床转归有关。空腹血糖高于或低于一定范围与死亡风险增加相关。进一步的研究应该探索这种关系，并为AKI危重患者寻找最佳的液体管理策略。
Introduction: We aimed to identify different trajectories of fluid balance (FB) and investigate the effect of FB trajectories on clinical outcomes in intensive care unit (ICU) patients with acute kidney injury (AKI) and the dose-response association between fluid overload (FO) and mortality. Methods: We derived data from the Beijing Acute Kidney Injury Trial (BAKIT). A total of 1,529 critically ill patients with AKI were included. The primary outcome was 28-day mortality, and hospital mortality, ICU mortality and AKI stage were the secondary outcomes. A group-based trajectory model was used to identify the trajectory of FB during the first 7 days. Multivariable logistic regression was performed to examine the relationship between FB trajectories and clinical outcomes. A logistic regression model with restricted cubic splines was used to examine the dose relationship between FO and 28-day mortality. Results: Three distinct trajectories of FB were identified: low FB (1,316, 86.1%), decreasing FB (120, 7.8%), and high FB (93, 6.1%). Compared with low FB, high FB was associated with increased 28-day mortality (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.17–3.19) and AKI stage (OR 2.04, 95% CI 1.23–3.37), whereas decreasing FB was associated with a reduction in 28-day mortality by approximately half (OR 0.53, 95% CI 0.32–0.87). Similar results were found for the outcomes of ICU mortality and hospital mortality. We observed a J-shaped relationship between maximum FO and 28-day mortality, with the lowest risk at a maximum FO of 2.8% L/kg. Conclusion: Different trajectories of FB in critically ill patients with AKI were associated with clinical outcomes. An FB above or below a certain range was associated with an increased risk of mortality. Further studies should explore this relationship and search for the optimal fluid management strategies for critically ill patients with AKI.