Lactated Ringer Is Associated With Reduced Mortality and Less Acute Kidney Injury in Critically Ill Patients: A Retrospective Cohort Analysis*
Lactated Ringer Is Associated With Reduced Mortality and Less Acute Kidney Injury in Critically Ill Patients: A Retrospective Cohort Analysis*
复制标题
乳酸林格氏液与危重患者死亡率降低和急性肾损伤减少相关：回顾性队列分析*
作者：
F. Zampieri;O. Ranzani;L. C. Azevedo;I. D. S. Martins;J. Kellum;A. Libório
目的：评估ICU入院前2天内输注的乳酸林格氏液百分比（%LR）对住院死亡率和急性肾损伤发生率的影响。设计：回顾性队列。设置：分析一个大型公共数据库（重症监护多参数智能监测-II）。患者：至少入住ICU 2天、入院肌酐低于5 mg/dL且在前48小时内接受至少500 mL液体的成人患者。干预措施：无。测量和主要结果：10，249例患者纳入死亡率分析，8，085例患者纳入急性肾损伤分析。对于急性肾损伤分析，我们排除了在ICU住院的前2天达到急性肾损伤标准的患者。急性肾损伤定义为2/3期肾病：改善总体结局肌酐标准，并在第3-7天进行评估。通过logistic回归控制混杂因素，评估%LR对两种结局的影响。应用主成分分析评估每种液体类型的体积对死亡率的影响。较高的%LR与较低的死亡率和较少的急性肾损伤相关。%LR效应随着输注液体总量的增加而增加。对于液体容量第四个四分位数（> 7 L）的患者，%LR等于75%与%LR等于25%的死亡率比值比为0.50（95%CI，0.32-0.79; p < 0.001）。主成分分析表明，乳酸林格液和0.9%生理盐水输注量对结局有相反的影响，有利于乳酸林格液。结论：较高的%LR与住院死亡率降低和ICU入院后3-7天急性肾损伤较少相关。%LR和死亡率之间的相关性受到输注液体总量的影响。
Objectives:To assess the impact of the percentage of fluid infused as Lactated Ringer (%LR) during the first 2 days of ICU admission in hospital mortality and occurrence of acute kidney injury. Design:Retrospective cohort. Setting:Analysis of a large public database (Multiparameter Intelligent Monitoring in Intensive Care-II). Patients:Adult patients with at least 2 days of ICU stay, admission creatinine lower than 5 mg/dL, and that received at least 500 mL of fluid in the first 48 hours. Interventions:None. Measurement and Main Results:10,249 patients were included in mortality analysis and 8,085 were included in the acute kidney injury analysis. For acute kidney injury analysis, we excluded patients achieving acute kidney injury criteria in the first 2 days of ICU stay. Acute kidney injury was defined as stage 2/3 Kidney Disease: Improving Global Outcomes creatinine criteria and was assessed from days 3–7. The effects of %LR in both outcomes were assessed through logistic regression controlling for confounders. Principal component analysis was applied to assess the effect of volume of each fluid type on mortality. Higher %LR was associated with lower mortality and less acute kidney injury. %LR effect increased with total volume of fluid infused. For patients in the fourth quartile of fluid volume (> 7 L), the odds ratio for mortality for %LR equal to 75% versus %LR equal to 25% was 0.50 (95% CI, 0.32–0.79; p < 0.001). Principal component analysis suggested that volume of Lactated Ringer and 0.9% saline infused had opposite effects in outcome, favoring Lactated Ringer. Conclusions:Higher %LR was associated with reduced hospital mortality and with less acute kidney injury from days 3–7 after ICU admission. The association between %LR and mortality was influenced by the total volume of fluids infused.
影响因子：
158.5
作者：
Martin, GS;Mannino, DM;Moss, M
通讯作者：
Moss, M