The risk associated with hyperoncotic colloids in patients with shock
The risk associated with hyperoncotic colloids in patients with shock
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DOI：
10.1007/s00134-008-1225-2
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发表时间：
2008-12-01
影响因子：
38.9
通讯作者：
Brochard, Laurent
中科院分区：
文献类型：
--
作者：
Schortgen, Frederique;Girou, Emmanuelle;Brochard, Laurent
晶体、人工胶体和天然胶体一直被认为是休克复苏的不同策略，但根据液体的肿瘤性特征区分液体可能是相关的。根据医生的选择，这项研究评估了使用低毒胶体、人工高毒胶体、高毒蛋白或晶体复苏的休克患者的肾脏不良事件的风险。国际前瞻性队列研究包括1,013名需要液体复苏以治疗休克的ICU患者。排除了患有肝硬变或接受血浆治疗的患者。通过多变量分析和倾向评分评估了不同类型的胶体和晶体对肾脏事件(肌酐增加两倍或需要透析)和死亡率的影响。统计调整是基于复苏时的严重程度、肾功能衰竭的风险因素以及影响医生对液体的偏好的变量。17%的患者发生了肾脏事件。在调整了潜在混杂因素和使用高肿瘤性胶体的倾向评分后，人工高肿瘤性胶体的使用[OR：2.48(1.24-4.97)]和高肿瘤性白蛋白[OR：5.99(2.75-13.08)]与肾事件的发生显著相关。ICU总死亡率为27.1%。使用高肿瘤性白蛋白与ICU死亡风险增加相关[OR：2.79(1.42-5.47)]。这项研究提示，高肿瘤性胶体可能对肾功能和预后产生有害影响。虽然不能排除这些化合物和混杂因素的不当使用，但应谨慎对待它们的使用，特别是因为存在合适的替代品。
Crystalloids, artificial and natural colloids have been opposed as representing different strategies for shock resuscitation, but it may be relevant to distinguish fluids based on their oncotic characteristics. This study assessed the risk of renal adverse events in patients with shock resuscitated using hypooncotic colloids, artificial hyperoncotic colloids, hyperoncotic albumin or crystalloids, according to physician's choice.International prospective cohort study including 1,013 ICU patients needing fluid resuscitation for shock. Patients suffering from cirrhosis or receiving plasma were excluded.Influence of different types of colloids and crystalloids on the occurrence of renal events (twofold increase in creatinine or need for dialysis) and mortality was assessed using multivariate analyses and propensity score. Statistical adjustment was based on severity at the time of resuscitation, risks factor for renal failure, and on variables influencing physicians' preferences regarding fluids. A renal event occurred in 17% of patients. After adjustment on potential confounding factors and on propensity score for the use of hyperoncotic colloids, the use of artificial hyperoncotic colloids [OR: 2.48 (1.24-4.97)] and hyperoncotic albumin [OR: 5.99 (2.75-13.08)] was significantly associated with occurrence of renal event. Overall ICU mortality was 27.1%. The use of hyperoncotic albumin was associated with an increased risk of ICU death [OR: 2.79 (1.42-5.47)].This study suggests that harmful effects on renal function and outcome of hyperoncotic colloids may exist. Although an improper usage of these compounds and confounding factors cannot be ruled out, their use should be regarded with caution, especially because suitable alternatives exist.