Relationship of body mass index, serum creatine kinase, and acute kidney injury after severe trauma.
Relationship of body mass index, serum creatine kinase, and acute kidney injury after severe trauma.
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DOI：
10.1097/ta.0000000000002714
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发表时间：
2020-07
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影响因子：
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通讯作者：
Shashaty MGS
中科院分区：
文献类型：
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作者：
Vasquez CR;DiSanto T;Reilly JP;Forker CM;Holena DN;Wu Q;Lanken PN;Christie JD;Shashaty MGS
身体质量指数（BMI）与创伤后急性肾损伤（阿基）相关，但其潜在机制尚不清楚。BMI与过度肥胖和肌肉质量增加有关。由于后者可能易患创伤后严重横纹肌溶解症，我们假设BMI与AKI的相关性可能部分由BMI与血清肌酸激酶（CK）的直接关系解释。对2005-2015年在一级创伤中心住院的463名危重患者进行的前瞻性队列研究，这些患者在前7天内损伤严重程度评分（ISS）>15，并测量血清CK。我们根据阿基网络肌酐标准定义阿基。我们使用简单线性回归确定BMI与峰值CK的相关性，使用多变量logistic回归调整峰值CK和混杂因素的BMI-AKI相关性。中位年龄为43岁，350例（76%）为男性，366例（79%）为钝性机制，中位ISS为24。BMI与CK峰值相关（R2 0.05，p<0.001）。148例患者（32%）发生阿基，出现后至CK峰值的中位时间为29（IQR 15-56）小时。在校正了年龄、种族、性别、糖尿病、损伤机制和严重程度以及红细胞输注的多变量模型中，BMI与阿基显著相关（OR 1.31/5 kg/m2，95% CI 1.09-1.58，p=0.004）。在模型中添加峰值CK部分减弱了BMI与阿基的相关性（OR 1.26/5 kg/m2，95% CI 1.04-1.52，p=0.018），峰值CK也与阿基相关（OR 1.19/自然对数，95% CI 1.00-1.41，p=0.049）。当仅限于数值<5000 U/l的患者时，峰值CK仍与阿基相关（OR 1.31/自然对数，95% CI 1.01-1.69，p=0.043）。血清CK与BMI相关，并部分减弱了严重创伤后BMI与阿基的相关性，表明过度的肌肉损伤可能有助于BMI-AKI的相关性。流行病学研究，III级
Body mass index (BMI) is associated with acute kidney injury (AKI) after trauma, but underlying mechanisms are unclear. BMI correlates with both excess adiposity and increased muscle mass. Since the latter could predispose to severe rhabdomyolysis after trauma, we hypothesized that the BMI-AKI association may be partially explained by a direct relationship of BMI with serum creatine kinase (CK). Prospective cohort study of 463 critically ill patients admitted to a Level I trauma center from 2005-2015 with injury severity score (ISS)>15 and serum CK measured in the first 7 days. We defined AKI by AKI Network creatinine criteria. We used simple linear regression to determine the association of BMI with peak CK, and multivariable logistic regression to adjust the BMI-AKI association for peak CK and confounders. Median age was 43 years, 350 (76%) were male, 366 (79%) had blunt mechanism, and median ISS was 24. BMI was associated with peak CK (R2 0.05, p<0.001). AKI developed in 148 patients (32%), and median time to peak CK was 29 (IQR 15-56) hours after presentation. BMI was significantly associated with AKI in multivariable models adjusted for age, race, sex, diabetes, injury mechanism and severity, and red blood cell transfusions (OR 1.31 per 5 kg/m2, 95% CI 1.09-1.58, p=0.004). Adding peak CK to the model partially attenuated the association of BMI with AKI (OR 1.26 per 5 kg/m2, 95% CI 1.04-1.52, p=0.018), and peak CK was also associated with AKI (OR 1.19 per natural log, 95% CI 1.00-1.41, p=0.049). Peak CK remained associated with AKI when restricted to patients with values<5000 U/l (OR 1.31 per natural log, 95% CI 1.01-1.69, p=0.043). Serum CK correlated with BMI and partially attenuated the association of BMI with AKI after major trauma, suggesting that excess muscle injury may contribute to the BMI-AKI association. Epidemiologic study, Level III