Elevated urea-to-creatinine ratio provides a biochemical signature of muscle catabolism and persistent critical illness after major trauma
Elevated urea-to-creatinine ratio provides a biochemical signature of muscle catabolism and persistent critical illness after major trauma
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DOI：
10.1007/s00134-019-05760-5
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发表时间：
2019-12-01
影响因子：
38.9
通讯作者：
Prowle, John R.
中科院分区：
文献类型：
--
作者：
Haines, Ryan W.;Zolfaghari, Parjam;Prowle, John R.
目的：肌肉萎缩在持续性危重病患者中很常见，并与尿素产生增加，但肌酐产生减少有关。我们假设，升高的尿素：肌酐比率将提供肌肉分解代谢的生化标志，并表征重大创伤后延长的重症监护(ICU)入院。方法：使用预先指定的假设，我们分析了两组现有的成人在重大创伤后进入ICU后存活10天的数据集。我们分析了为伦敦东北部和埃塞克斯创伤网络服务的主要创伤中心的创伤ICU入院情况，并从MIMIC-III数据库中核实了创伤ICU病例队列。我们比较了持续危重病患者(定义为ICU住院10天)和10天前出院患者的血清尿素、肌酐和尿素：肌酐比率(以浓度/L表示)。在接受连续腹部计算机断层扫描(CT)的亚组中，我们测量横切肌面积(L4椎体水平的腰大肌和L3水平的总肌肉)的变化，并评估与尿素：肌酐比率和ICU停留时间的关系。结果以中位数[四分位数范围]提供。结果：我们纳入了2012年2月1日至2016年5月1日期间的1173名患者。在ICU住院天数为10天的患者中，第10天的尿素：肌酐比值增加了133%，从62[46-78]增加到141[114-178]，P<；0.001；这一上升幅度(P<；0.001)大于第10天前出院患者的59%[11-122%]，61[45-75]到97[67-128]，P<；0.001。从MIMIC-III的2876例创伤ICU住院患者中观察到类似的尿素：肌酐比率的分离轨迹。107例连续行CT的患者中，L4腰大肌和L3肌横截面积的减少与时间显著相关(R2=0.64和R2=0.59)。在进展中的、当前的或近期的持续性危重疾病期间，接受第二次CT检查的53名患者的肌肉减少率显著更大(P<；交互作用为0.001)。在本组中，在第二次CT时，尿素/肌酐比值与L4腰大肌和L3肌肉横截面积呈负相关(R-20.39，p<；0.001和0.44，p<；0.001)。结论：严重创伤后伴随着骨骼肌萎缩，代表持续危重疾病的生化特征。如果前瞻性证实，尿素：肌酐比率是在流行病学和干预性研究中潜在的分解代谢替代指标。
Purpose: Muscle wasting is common amongst patients with persistent critical illness and associated with increased urea production, but reduced creatinine production. We hypothesised that elevated urea:creatinine ratio would provide a biochemical signature of muscle catabolism and characterise prolonged intensive care (ICU) admissions after major trauma.Methods: Using pre-specified hypotheses, we analysed two existing data sets of adults surviving >= 10 days following admission to ICU after major trauma. We analysed trauma-ICU admissions to the major trauma centre serving the North East London and Essex Trauma Network, with a verification cohort of trauma-ICU cases from the MIMIC-III database. We compared serum urea, creatinine, and urea:creatinine ratio (ratio of concentrations in mmol/L) between patients with persistent critical illness (defined as ICU stay of >= 10 days) and those discharged from ICU before day 10. In a sub-group undergoing sequential abdominal computerised tomography (CT), we measured change in cross-sectional muscle area (psoas muscle at L4 vertebral level and total muscle at L3 level) and assessed for relationships with urea:creatinine ratio and ICU stay.Results are provided as median [interquartile range]. Results: We included 1173 patients between February 1st, 2012 and May 1st, 2016. In patients with ICU stay >= 10 days, day 10 urea:creatinine ratio had increased by 133% [72-215], from 62 [46-78] to 141 [114-178], p < 0.001; this rise was larger (p < 0.001) than in patients discharged from ICU before day 10, 59% [11-122%], 61 [45-75] to 97 [67-128], p < 0.001. A similar separation in trajectory of urea:creatinine ratio was observed in 2876 trauma-ICU admissions from MIMIC-III. In 107 patients undergoing serial CTs, decrease in L4 psoas and L3 muscle cross-sectional areas between CTs significantly correlated with time elapsed (R-2 = 0.64 and R-2 = 0.59, respectively). Rate of muscle decrease was significantly greater (p < 0.001 for interaction terms) in 53/107 patients with the second CT during evolving, current or recent persistent critical illness. In this group, at the second CT urea:creatinine ratio negatively correlated with L4 psoas and L3 muscle cross-sectional areas (R-2 0.39, p < 0.001 and 0.44, p < 0.001).Conclusion: Elevated urea:creatinine ratio accompanies skeletal muscle wasting representing a biochemical signature of persistent critical illness after major trauma. If prospectively confirmed, urea:creatinine ratio is a potential surrogate of catabolism to examine in epidemiological and interventional studies.