Prediction of early acute kidney injury after trauma using prehospital systolic blood pressure and lactate levels: A prospective validation study
Prediction of early acute kidney injury after trauma using prehospital systolic blood pressure and lactate levels: A prospective validation study
复制标题
使用院前收缩压和乳酸水平预测创伤后早期急性肾损伤：一项前瞻性验证研究
DOI：
10.1016/j.injury.2021.09.039
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发表时间：
2022
期刊：
影响因子：
2.5
通讯作者：
Kato Seiya
中科院分区：
文献类型：
--
作者：
Nasu Toru;Ueda Kentaro;Kawashima Shuji;Okishio Yuko;Kunitatsu Kosei;Iwasaki Yasuhiro;Kato Seiya
创伤后急性肾损伤（AKI）是与住院时间延长和死亡率增加独立相关的主要并发症。我们之前报道过院前收缩压（SBP）和医院早期动脉乳酸水平，以及特定的临界值，使用AUC-ROC[1]对AKI的早期预测有很好的效果。本研究的目的是前瞻性地验证这些参数是否可以预测创伤后新发生的AKI。方法对2019年1月至12月在单一创伤中心住院的创伤患者进行前瞻性回顾。年龄<16岁、有烧伤和慢性肾脏疾病的患者被排除在外。AKI是根据单独基于血清肌酐的风险、损伤、衰竭、肾功能丧失和终末期肾病（RIFLE）分类来定义的。院前收缩压低（≤126 mmHg）、乳酸水平高（≥2.5 mmol/L）的患者定义为高危组，其他患者定义为低危组。结果我院共收治创伤患者489例，其中403例符合研究条件。高危组38例，低危组365例。高危组损伤衰竭期严重AKI发生率（5例，13.2%）显著高于低危组（7例，1.9%），优势比为7.75,95%可信区间为2.33-25.77。结论这些预测因子对创伤后严重AKI的早期预测有较好的效果。早期预测创伤后严重AKI的高危人群，提示早期治疗，有助于改善创伤患者的预后。
BackgroundAcute kidney injury (AKI) after trauma is a major complication independently associated with a prolonged hospital stay and increased mortality. We previously reported that the prehospital systolic blood pressure (SBP) and early hospital arterial lactate level, along with specific cut-off values, show good performance in the early prediction of AKI using AUC-ROC [1]. The purpose of this study was to prospectively validate whether or not these parameters are predictive of newly occurring AKI after trauma.MethodsThis was a prospective review of trauma patients who were admitted to a single trauma center from January to December 2019. Patients who were <16 years old, who had burns, and who had chronic kidney disease were excluded. AKI was defined according to the Risk, Injury, Failure, Loss of the kidney function, and End-stage kidney disease (RIFLE) classification based on serum creatinine alone. Patients with a low prehospital SBP (≤126 mmHg) and high lactate levels (≥2.5 mmol/L) were defined as the high-risk group, and other patients were defined as the low-risk group.ResultsA total of 489 trauma patients were admitted to our center, of whom 403 were eligible for the study. The high-risk group consisted of 38 patients, and the low-risk group consisted of 365 patients. The incidence of severe AKI in Stage Injury and Failure was significantly higher in the high-risk group (5 patients, 13.2%) than in the low-risk group (7 patients, 1.9%), with an odds ratio of 7.75 and 95% confidence interval of 2.33–25.77.ConclusionsThese predictors showed good performance in the early prediction of severe AKI after trauma. Early prediction of the high-risk groups for severe AKI after trauma prompting early treatment may help improve the prognosis of trauma patients.