The impact of fluid balance on diagnosis, staging and prediction of mortality in critically ill patients with acute kidney injury
The impact of fluid balance on diagnosis, staging and prediction of mortality in critically ill patients with acute kidney injury
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DOI：
10.1007/s40620-015-0211-3
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发表时间：
2016-04-01
影响因子：
3.4
通讯作者：
Kashani, Kianoush
中科院分区：
文献类型：
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作者：
Thongprayoon, Charat;Cheungpasitporn, Wisit;Kashani, Kianoush
液体积聚可能会延迟重症监护病房(ICU)患者对急性肾损伤(AKI)的识别。本研究旨在评估液体平衡对危重病患者AKI的发生率、诊断时间和预后预测的影响。该研究包括2011年梅奥诊所医院7696名成年ICU患者的队列，其中至少有一名ICU患者在ICU中测量了血清肌酐(Scr)。AKI是根据KDIGO定义第一阶段的SCR标准定义的。研究比较了SCR调整液体平衡前后急性肾损伤的发生率和对60天死亡率的预测效果。急性肾损伤发生在液体平衡调整前的1860例(24.2%)，液体平衡调整后的1947例(25.3%)(P<；0.001)。SCR调整前后AKI患者的60d死亡率显著高于未发生AKI患者(OR 3.38；95%CI 2.84-4.02)。SCR调整后但未调整前符合AKI标准的患者60天死亡风险显著高于未调整AKI的患者(OR 2.00；95%CI 1.25-3.11)。相比之下，在SCR调整前符合AKI标准但在SCR调整后不符合AKI标准的患者60天死亡的风险与没有AKI的患者相似(OR 1.19；95%CI 0.48-2.50)。调整前和调整后的Scr预测60d死亡率的C统计量分别为0.68和0.70(P=0.001)。我们的研究发现，调整Scr可以更准确地检测急性肾损伤病例。我们建议对容量超负荷的危重患者使用液体平衡调节。
Fluid accumulation may delay recognition of acute kidney injury (AKI) in intensive care unit (ICU) patients. This study aims to evaluate the impact of fluid balance on the incidence, time of AKI diagnosis and predictive performance for outcomes of critically ill patients.This study included a cohort of 7696 adult ICU patients at Mayo Clinic Hospital in year 2011 with at least one serum creatinine (SCr) measured in ICU. AKI was defined based on SCr criterion for stage I of KDIGO definition. The AKI incidence and predictive performance for 60-day mortality was compared before and after SCr adjustment for fluid balance.AKI was detected in 1860 (24.2 %) before and 1947 (25.3 %) after fluid balance adjustment (P < 0.001). Patients with AKI both before and after SCr adjustment had significantly higher 60-day mortality in comparison with patients who did not develop AKI (OR 3.38; 95 % CI 2.84-4.02). The risk of 60-day mortality in patients who met AKI criteria after but not before SCr adjustment was significantly higher than patients without AKI (OR 2.00; 95 % CI 1.25-3.11). In contrast, the risk of 60-day mortality in patients who met AKI criteria before but not after SCr adjustment was similar to patients without AKI (OR 1.19; 95 % CI 0.48-2.50). The C-statistic for unadjusted and adjusted SCr to predict 60-day mortality were 0.68 and 0.70, respectively (P = 0.001).Our study found that SCr adjustment for fluid balance could result in a more accurate detection of AKI cases. We suggest using fluid balance adjustment for volume overload critically ill patients.