Assessment of Modification of Diet in Renal Disease Equation to Predict Reference Serum Creatinine Value in Severe Trauma Patients: Lessons From an Observational Study of 775 Cases
Assessment of Modification of Diet in Renal Disease Equation to Predict Reference Serum Creatinine Value in Severe Trauma Patients: Lessons From an Observational Study of 775 Cases
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DOI：
10.1097/sla.0000000000001163
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发表时间：
2016-04-01
影响因子：
9
通讯作者：
Charbit, Jonathan
中科院分区：
文献类型：
--
作者：
Saour, Marine;Klouche, Kada;Charbit, Jonathan
目的：我们评估了肾脏疾病饮食改良（MDRD）预测血清肌酐（SCr）在严重创伤人群中的表现，并确定了最佳的理论肾小球滤过率（GFR），用于此estimation.Background：严重创伤患者的基线SCr可能会被错误估计，因为他们的具体人口统计学特征，包括肾超滤。然而，反算MDRD方程应该使用预定的GFR 75 mL/min/1.73 m（2）来估计SCr。方法：回顾性纳入2005年1月至2011年1月期间所有SCr正常的严重创伤患者。对于每例患者，使用第一周期间观察到的最低SCr（oSCr）估计GFR。测定第1阶段（2005-2006年）的中位GFR。在第2阶段评估了反算MDRD性能（2007-2011）使用GFR 75 mL/min/1.73 m（2）（eSCr（75）-MDRD）或第1阶段观察到的中位GFR，通过一致性、精密度和准确度预测oSCr结果：共研究了775例患者：平均年龄37.717岁;平均损伤严重度评分19 +/- 11; 75%为男性。在第1阶段（n = 243），中位GFR为121 mL/min/1.73 m（2）。在第2阶段（n = 532），eSCr（TRAUMA）-MDRD在预测oSCr方面比eSCr（75）-MDRD表现出更好的一致性（平均偏倚2 vs 35 mol/L; P < 0.001）。eSCr（TRAUMA）-MDRD的精密度（分别为14 vs 39 mol/L）和准确度均显著提高。eSCr（TRAUMA）-MDRD组SCr估计值偏差小于15%、30%或50%的比例也较高（P < 0.001）。结论：eSCr（75）-MDRD方程系统性高估了严重创伤患者的oSCr。确定的eSCr（创伤）-MDRD方程具有统计学上的上级优势，可更准确地鉴定急性肾损伤。
Objective:We assessed the Modification of Diet in Renal Disease (MDRD) performance to predict serum creatinine (SCr) in severe trauma population and determined the best theoretical glomerular filtration rate (GFR) to use in this estimation.Background:Baseline SCr may be misestimated in severe trauma patients because of their specific demographic characteristics including renal hyperfiltration. However, the back-calculated MDRD equation is supposed to estimate SCr using a predetermined GFR of 75mL/min/1.73m(2).Methods:All severe trauma patients with a normal SCr were retrospectively included between January 2005 and January 2011. For each patient, the lowest SCr (oSCr) observed during the first week was used to estimate the GFR. The median GFR in period 1 (2005-2006) was determined. The back-calculated MDRD performance was assessed in period 2 (2007-2011) to predict oSCr by agreement, precision, and accuracy using a GFR of 75mL/min/1.73m(2) (eSCr(75)-MDRD) or the median GFR observed in period 1 (eSCr(TRAUMA)-MDRD).Results:A total of 775 patients were studied: mean age, 37.717 years; mean Injury Severity Score, 19 +/- 11; 75% of male. In period 1 (n = 243), median GFR was 121mL/min/1.73m(2). In period 2 (n = 532), eSCr(TRAUMA)-MDRD demonstrated better agreement in predicting oSCr than eSCr(75)-MDRD (mean bias 2 vs 35mol/L; P < 0.001). Both precision (14 vs 39mol/L, respectively) and accuracy were significantly improved with eSCr(TRAUMA)-MDRD. Proportion of estimated SCr values that deviated less than 15%, 30%, or 50% was also higher with eSCr(TRAUMA)-MDRD (P < 0.001).Conclusions:The eSCr(75)-MDRD equation systematically overestimates oSCr of severe trauma patients. The eSCr(TRAUMA)-MDRD equation determined was statistically superior allowing more accurate qualification of acute kidney injury.