Utilization of Small Changes in Serum Creatinine with Clinical Risk Factors to Assess the Risk of AKI in Critically lll Adults
Utilization of Small Changes in Serum Creatinine with Clinical Risk Factors to Assess the Risk of AKI in Critically lll Adults
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DOI：
10.2215/cjn.05190513
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发表时间：
2014-04-07
影响因子：
9.8
通讯作者：
Ronco, Claudio
中科院分区：
文献类型：
--
作者：
Cruz, Dinna N.;Ferrer-Nadal, Asuncion;Ronco, Claudio
背景和目的疾病生物标志物需要适当的临床背景才能有效地使用。除了血清肌酐的微小变化外，还建议结合临床风险因素来改善阿基的评估。这一概念的提出是为了在患者的临床病程早期识别阿基的风险。我们着手评估这种组合approaches.Design，设置，参与者，和measurementsA二次分析的数据，从一个前瞻性的多中心重症监护病房队列研究（2009年9月至2010年4月）进行。使用这种联合方法的高风险患者定义为血清肌酐早期增加0.1-0.4 mg/dl，这取决于易患阿基的临床因素的数量。使用急性肾损伤网络标准对阿基进行定义和分期。主要结果是在重症监护室7天内演变为严重阿基（急性肾损伤网络阶段2和3）。ResultsOf 506例患者中，214例（42.2%）患者早期肌酐升高，被认为是阿基的高风险。这一组更有可能随后发生主要终点（16.4%对1.0% [非高危]，P
Background and objectivesDisease biomarkers require appropriate clinical context to be used effectively. Combining clinical risk factors, in addition to small changes in serum creatinine, has been proposed to improve the assessment of AKI. This notion was developed in order to identify the risk of AKI early in a patient's clinical course. We set out to assess the performance of this combination approach.Design, setting, participants, & measurementsA secondary analysis of data from a prospective multicenter intensive care unit cohort study (September 2009 to April 2010) was performed. Patients at high risk using this combination approach were defined as an early increase in serum creatinine of 0.1-0.4 mg/dl, depending on number of clinical factors predisposing to AKI. AKI was defined and staged using the Acute Kidney Injury Network criteria. The primary outcome was evolution to severe AKI (Acute Kidney Injury Network stages 2 and 3) within 7 days in the intensive care unit.ResultsOf 506 patients, 214 (42.2%) patients had early creatinine elevation and were deemed at high risk for AKI. This group was more likely to subsequently develop the primary endpoint (16.4% versus 1.0% [not at high risk], P