3-month prognostic impact of severe acute renal failure under veno-venous ECMO support: Importance of time of onset
3-month prognostic impact of severe acute renal failure under veno-venous ECMO support: Importance of time of onset
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DOI：
10.1016/j.jcrc.2017.10.022
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发表时间：
2018-04-01
影响因子：
3.7
通讯作者：
Silva, S.
中科院分区：
文献类型：
--
作者：
Delmas, C.;Zapetskaia, T.;Silva, S.
目的：静脉-静脉 ECMO 越来越多地用于治疗难治性 ARDS。在这种情况下，急性肾损伤（AKI）是一种主要且常见的并发症，通常与不良预后相关。我们的目的是确定与严重肾衰竭（改善肾脏疾病全球结局 (KDIGO) 3）相关的特征及其对 3 个月结局的影响。方法：2009 年 5 月至 2016 年 4 月期间，前瞻性纳入我们大学医院需要 VV-ECMO 的 60 名成年患者。结果：AKI 发生频繁（75%；n = 45），51% 的患者（n = 31）出现 KDIGO 3 - 主要是在 ECMO 植入之前 - 43% (n = 26) 的病例需要肾脏替代治疗。 KDIGO 3 与较低的机械通气撤机率（无 AKI 或其他 AKI 阶段的患者为 24% vs 68%；p < 0.001）和较高的 90 天死亡率相关（72% vs 32%，p = 0.002）。多变量logistic回归提示ECMO置入前KDIGO 3的发生以及PaCO2 > 57 mm Hg和mSOFA > 12是90天死亡率的独立危险因素。结论：KDIGO 3 AKI的发生与ECMO置入前患者临床状况的严重程度相关，与90天生存率呈负相关。 (C) 2017 Elsevier Inc. 保留所有权利。
Purpose: Veno-venous ECMO is increasingly used for the management of refractory ARDS. In this context, acute kidney injury (AKI) is a major and frequent complication, often associated with poor outcome. We aimed to identify characteristics associated with severe renal failure (Kidney Disease Improving Global Outcome (KDIGO) 3) and its impact on 3-month outcome.Methods: Between May 2009 and April 2016, 60 adult patients requiring VV-ECMO in our University Hospital were prospectively included.Results: AKI occurrence was frequent (75%; n = 45), 51% of patients (n = 31) developed KDIGO 3 - predominantly prior to ECMO insertion - and renal replacement therapy was required in 43% (n = 26) of cases. KDIGO 3 was associated with a lower mechanical ventilation weaning rate (24% vs 68% for patients with no AKI or other stages of AKI; p < 0.001) and a higher 90-day mortality rate (72% vs 32%, p = 0.002). Multivariate logistic regression suggested that KDIGO 3 occurrence prior to ECMO insertion, as well as PaCO2 > 57 mm Hg and mSOFA > 12 were independent risks factors for 90-day mortality.Conclusion: KDIGO 3 AKI occurrence is correlated with the severity of patients' clinical condition prior to ECMO insertion and is negatively associated with 90-day survival. (C) 2017 Elsevier Inc. All rights reserved.