Association Between Furosemide Exposure and Clinical Outcomes in a Retrospective Cohort of Critically Ill Children.
Association Between Furosemide Exposure and Clinical Outcomes in a Retrospective Cohort of Critically Ill Children.
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DOI：
10.3389/fped.2020.589124
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发表时间：
2020
影响因子：
2.6
通讯作者：
Li Y
中科院分区：
文献类型：
--
作者：
Dai X;Chen J;Li W;Bai Z;Li X;Wang J;Li Y
呋塞米通常用于重症患者，以增加尿量并预防液体过载（FO）和急性肾损伤（阿基），但没有确凿的证据支持。关于呋塞米是否与阿基和不良结局相关，仍有相互矛盾的研究结果。关于呋塞米对儿科重症监护病房（PICU）一般人群不良结局影响的信息有限。队列研究的目的是调查呋塞米与重症儿童阿基和临床结局的相关性。研究设计：我们回顾性分析了2016年1月至12月连续入住PICU的456名危重儿童。关注的暴露是入院后第一周使用呋塞米。FO定义为每日液体蓄积≥5%，当第一周内平均每日液体蓄积≥ 5%时，平均FO被认为具有显著性。主要结局是入院后第一周的阿基和PICU住院期间的死亡率。阿基诊断基于肾脏疾病：改善全球结局标准，同时考虑血清肌酸酐和尿量。结果如下：所有患者（n = 456）中有43.4%的患者在入院后第一周内暴露于呋塞米，发生FO的患者（n = 150）中有49.3%。暴露于呋塞米的患者的平均每日液体蓄积程度显著低于未暴露于呋塞米的患者（1.10 [-0.33至2.61%] vs. 2.00 [0.54-3.70%]，P < 0.001）。接受和未接受呋塞米治疗的患者阿基发生率无差异（22/198 [11.1%] vs. 36/258 [14.0%]，P = 0.397）。死亡率为15.4%（70/456），接受呋塞米治疗的患者死亡率高于未接受呋塞米治疗的患者（21.7% vs. 10.5%，P = 0.002）。在多变量逻辑回归模型中，根据体重、性别、通过PRISM III评分评估的疾病严重程度、平均FO的存在和阿基分期进行调整后，呋塞米暴露与死亡几率增加相关[调整后的比值比（AOR）1.95; 95%CI，1.08-3.52; P = 0.026]。结论：在危重患儿中，呋塞米暴露可能与死亡风险增加相关，但与阿基无关。
Furosemide is commonly prescribed in critically ill patients to increase the urine output and prevent fluid overload (FO) and acute kidney injury (AKI), but not supported by conclusive evidence. There remain conflicting findings on whether furosemide associates with AKI and adverse outcomes. Information on the impact of furosemide on adverse outcomes in a general population of pediatric intensive care unit (PICU) is limited. The aim of the cohort study was to investigate the associations of furosemide with AKI and clinical outcomes in critically ill children. Study Design: We retrospectively reviewed a cohort of 456 critically ill children consecutively admitted to PICU from January to December 2016. The exposure of interest was the use of furosemide in the first week after admission. FO was defined as ≥5% of daily fluid accumulation, and mean FO was considered significant when mean daily fluid accumulation during the first week was ≥5%. The primary outcomes were AKI in the first week after admission and mortality during PICU stay. AKI diagnosis was based on Kidney Disease: Improving Global Outcomes criteria with both serum creatinine and urine output. Results: Furosemide exposure occurred in 43.4% of all patients (n = 456) and 49.3% of those who developed FO (n = 150) in the first week after admission. Patients who were exposed to furosemide had significantly less degree of mean daily fluid accumulation than those who were not (1.10 [−0.33 to 2.61%] vs. 2.00 [0.54–3.70%], P < 0.001). There was no difference in the occurrence of AKI between patients who did and did not receive furosemide (22 of 198 [11.1%] vs. 36 of 258 [14.0%], P = 0.397). The mortality rate was 15.4% (70 of 456), and death occurred more frequently among patients who received furosemide than among those who did not (21.7 vs. 10.5%, P = 0.002). Furosemide exposure was associated with increased odds for mortality in a multivariate logistic regression model adjusted for body weight, gender, illness severity assessed by PRISM III score, the presence of mean FO, and AKI stage [adjusted odds ratio (AOR) 1.95; 95%CI, 1.08–3.52; P = 0.026]. Conclusion: Exposure to furosemide might be associated with increased risk for mortality, but not AKI, in critically ill children.
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DOI：
10.1186/s13054-018-2192-9
发表时间：
2018-10-10
期刊：
Critical care (London, England)
影响因子：
--
作者：
Jeon J;Kim DH;Baeg SI;Lee EJ;Chung CR;Jeon K;Lee JE;Huh W;Suh GY;Kim YG;Kim DJ;Oh HY;Jang HR
通讯作者：
Jang HR
影响因子：
2.4
作者：
Bai Z;Zhu X;Li M;Hua J;Li Y;Pan J;Wang J;Li Y
通讯作者：
Li Y
影响因子：
8.3
作者：
Hsu, Wan-Ting;Galm, Brandon Patrick;Lee, Chien-Chang
通讯作者：
Lee, Chien-Chang
影响因子：
5.1
作者：
ENGELHARDT, B;ELLIOTT, S;HAZINSKI, TA
通讯作者：
HAZINSKI, TA
DOI：
10.1186/cc10269
发表时间：
2011-06-10
期刊：
Critical care (London, England)
影响因子：
--
作者：
Alkandari O;Eddington KA;Hyder A;Gauvin F;Ducruet T;Gottesman R;Phan V;Zappitelli M
通讯作者：
Zappitelli M