Assessment of prescribed vs. achieved fluid balance during continuous renal replacement therapy and mortality outcome.
Assessment of prescribed vs. achieved fluid balance during continuous renal replacement therapy and mortality outcome.
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在连续的肾脏替代疗法和死亡率结果期间，评估处方与达到的流体平衡。
DOI：
10.1371/journal.pone.0272913
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Goldstein, Stuart L.
中科院分区：
文献类型：
--
作者：
Neyra, Javier A.;Lambert, Joshua;Ortiz-Soriano, Victor;Cleland, Daniel;Colquitt, Jon;Adams, Paul;Bissell, Brittany D.;Chan, Lili;Nadkarni, Girish N.;Tolwani, Ashita;Goldstein, Stuart L.
连续性肾脏替代治疗（CRRT）期间的液体管理，需要准确设定患者期望达到的液体平衡量（FBGoal），并精准实现患者实际达到的液体平衡量（FBAchieved）。在此，我们研究了CRRT期间患者处方液体平衡量与实际达到的液体平衡量之间的差距（%FBGap）与危重症患者住院死亡率的关系。
本研究为队列研究，纳入对象为患有急性肾损伤（AKI）且需要接受CRRT并处方负液体平衡（患者平均每日负液体平衡目标量≥0.5升）的成年危重症患者。液体管理参数包括：1）净超滤率（NUF）；2）FBGoal；3）FBAchieved；4）FBGap（实际达到的液体平衡量与目标量之间的差距百分比），所有参数均根据患者体重（千克）和CRRT持续时间（小时）进行校正。
研究分析了653例患者的数据（CRRT中位时长为102.2患者 - 小时）。患者平均（标准差）年龄为56.7（14.6）岁，男性占61.9%。住院死亡率为64%。尽管死亡患者与存活患者的FBGoal相似，但存活患者在CRRT期间实现的负液体平衡量大于非存活患者：FBAchieved中位数分别为 - 0.25 [-0.52至 - 0.05] 与0.06 [-0.26至0.62] 毫升/千克/小时，P < 0.001。死亡患者的NUF中位数低于存活患者：分别为1.06 [0.63 - 1.47] 与1.22 [0.82 - 1.69] 毫升/千克/小时，P < 0.001，且死亡患者的%FBGap中位数高于存活患者（分别为112.8%，61.5至165.7 与64.2%，30.5至91.8），P < 0.001。在多变量模型中，较高的%FBGap与住院死亡风险增加独立相关：校正后的优势比（aOR，95%置信区间）为1.01（1.01 - 1.02），P < 0.001。在校正%FBGap及其他临床参数后，NUF与住院死亡率无关：aOR为0.96（0.72 - 1.28），P = 0.771。
对于接受CRRT且临床医生通过CRRT处方负液体平衡的患有AKI的成年危重症患者，较高的%FBGap与住院死亡风险增加独立相关。%FBGap代表了CRRT实施过程中的一个新的质量指标，有助于在CRRT期间实施液体管理干预措施。
Fluid management during continuous renal replacement therapy (CRRT) requires accuracy in the prescription of desired patient fluid balance (FBGoal) and precision in the attainable patient fluid balance (FBAchieved). Herein, we examined the association of the gap between prescribed vs. achieved patient fluid balance during CRRT (%FBGap) with hospital mortality in critically ill patients. Cohort study of critically ill adults with acute kidney injury (AKI) requiring CRRT and a prescription of negative fluid balance (mean patient fluid balance goal of negative ≥0.5 liters per day). Fluid management parameters included: 1) NUF (net ultrafiltration rate); 2) FBGoal; 3) FBAchieved; and 4) FBGap (% gap of fluid balance achieved vs. goal), all adjusted by patient’s weight (kg) and duration of CRRT (hours). Data from 653 patients (median of 102.2 patient-hours of CRRT) were analyzed. Mean (SD) age was 56.7 (14.6) years and 61.9% were male. Hospital mortality rate was 64%. Despite FBGoal was similar in patients who died vs. survived, survivors achieved greater negative fluid balance during CRRT than non-survivors: median FBAchieved -0.25 [-0.52 to -0.05] vs. 0.06 [-0.26 to 0.62] ml/kg/h, p<0.001. Median NUF was lower in patients who died vs. survived: 1.06 [0.63–1.47] vs. 1.22 [0.82–1.69] ml/kg/h, p<0.001, and median %FBGap was higher in patients who died (112.8%, 61.5 to 165.7) vs. survived (64.2%, 30.5 to 91.8), p<0.001. In multivariable models, higher %FBGap was independently associated with increased risk of hospital mortality: aOR (95% CI) 1.01 (1.01–1.02), p<0.001. NUF was not associated with hospital mortality when adjusted by %FBGap and other clinical parameters: aOR 0.96 (0.72–1.28), p = 0.771. Higher %FBGap was independently associated with an increased risk of hospital mortality in critically ill adults with AKI on CRRT in whom clinicians prescribed negative fluid balance via CRRT. %FBGap represents a novel quality indicator of CRRT delivery that could assist with operationalizing fluid management interventions during CRRT.
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DOI：
10.1056/nejmoa1611391
发表时间：
2017-01-05
期刊：
The New England journal of medicine
影响因子：
--
作者：
Kaddourah A;Basu RK;Bagshaw SM;Goldstein SL;AWARE Investigators
通讯作者：
AWARE Investigators
影响因子：
4.6
作者：
Ruiz EF;Ortiz-Soriano VM;Talbott M;Klein BA;Thompson Bastin ML;Mayer KP;Price EB;Dorfman R;Adams BN;Fryman L;Neyra JA;University of Kentucky CRRT Quality Assurance Group
通讯作者：
University of Kentucky CRRT Quality Assurance Group
影响因子：
6.1
作者：
Heung, Michael;Wolfgram, Dawn F.;Ojo, Akinlolu O.
通讯作者：
Ojo, Akinlolu O.
影响因子：
19.6
作者：
Bouchard, Josee;Soroko, Sharon B.;Mehta, Ravindra L.
通讯作者：
Mehta, Ravindra L.
影响因子：
13.8
作者：
Murugan, Raghavan;Kerti, Samantha J.;Bellomo, Rinaldo
通讯作者：
Bellomo, Rinaldo