Prehospital Blood Pressure and Lactate are Early Predictors of Acute Kidney Injury After Trauma
Prehospital Blood Pressure and Lactate are Early Predictors of Acute Kidney Injury After Trauma
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DOI：
10.1016/j.jss.2021.03.037
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发表时间：
2021-04-30
影响因子：
2.2
通讯作者：
Kato, Seiya
中科院分区：
文献类型：
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作者：
Nasu, Toru;Ueda, Kentaro;Kato, Seiya
背景：本研究的目的是报告本中心创伤后急性肾损伤（AKI）的患病率，描述与AKI相关的危险因素，并确定这些危险因素是否有助于避免AKI。材料和方法：我们回顾性分析了2017年1月至2018年12月从单中心创伤登记处前瞻性收集的数据。年龄< 16岁的患者、患有烧伤的患者和患有慢性肾脏疾病的患者被排除在本研究之外。AKI的定义是根据风险、损伤、肾功能衰竭、肾功能丧失和终末期肾脏疾病（RIFLE）的血清肌酐分类。进行logistic回归分析以确定院前和院早期AKI的危险因素。结果：数据库共记录创伤患者806例。根据上述排除标准排除了130例病例。676名患者被纳入分析。总体人群AKI患病率为14.5%，其中R期为10.5%，I期为3.0%，f期为1.0%。在失血性休克患者亚组中AKI发病率分别上升至36.3%，12.1%和3.3%。多因素分析显示院前最低收缩压和动脉乳酸水平是AKI的独立预测因子。该模型对AKI I期和f期的预测具有良好的判别能力，受试者工作特征曲线下面积（AUC-ROC）分别为0.867和0.852，临界值分别为126 mmHg和2.5 mmol/L。结论：这些参数对创伤后AKI的早期预测有较好的效果。它们与创伤后AKI的早期发病有关，可能是预防AKI治疗效果的早期预测指标。(c) 2021爱思唯尔公司版权所有。
Background: The purpose of this study is to report the prevalence of acute kidney injury (AKI) after trauma in our center, describe the risk factors associated with AKI, and determine whether these risk factors help avoid AKI. Materials and Methods: We retrospectively analyzed the data which were prospectively collected from a single center trauma registry from January 2017 to December 2018. Patients who were < 16 years of age, patients with bums, and patients with chronic kidney disease were excluded from the present study. AKI was defined according to the risk, injury, failure, loss of the kidney function, and end-stage kidney disease (RIFLE) classification from serum creatinine alone. A logistic regression analysis was performed to identify prehospital and early hospital risk factors for AKI. Results: There were 806 trauma patients recorded in the database. One hundred thirty cases were excluded based on the abovementioned exclusion criteria. Six hundred seventy-six patients were included in the analysis. The prevalence of AKI in the overall population was 14.5% including 10.5% of patients with stage R, 3.0% of patients with stage I and 1.0% with stage F. The incidence of AKI increased to 36.3%, 12.1% and 3.3% in the subgroup of patients with hemorrhagic shock. The multivariate analysis revealed that the minimum prehospital systolic blood pressure and arterial lactate level were independent predictors of AKI. The model showed good discrimination with an area under the receiver operating characteristic curve (AUC-ROC) of 0.867 and 0.852 in the prediction of AKI stage I or F. The cutoff values were 126 mmHg and 2.5 mmol/L, respectively. Conclusion: These parameters showed good performance in the early prediction of AKI after trauma. They are associated with the early onset of AKI after trauma and may be an early predictor of the effects of treatment to prevent AKI. (c) 2021 Elsevier Inc. All rights reserved.