Effect of timing of dialysis on mortality in critically ill, septic patients with acute renal failure
Effect of timing of dialysis on mortality in critically ill, septic patients with acute renal failure
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DOI：
10.1111/j.1542-4758.2009.00407.x
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发表时间：
2010-01-01
影响因子：
1.3
通讯作者：
Gehr, Todd W. B.
中科院分区：
文献类型：
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作者：
Carl, Daniel E.;Grossman, Catherine;Gehr, Todd W. B.
重症监护室中急性肾衰竭伴脓毒症与显著的死亡率相关。本研究的目的是确定脓毒症患者开始肾脏替代治疗（RRT）的时间是否对28天死亡率有影响。纳入了需要RRT的脓毒症和急性肾衰竭内科重症监护室患者的回顾性数据。以血尿素氮（BUN）< 100 mg/dL开始肾脏替代治疗定义为“早期”开始，以BUN >= 100 mg/dL开始定义为“晚期”开始。对RRT开始后第14、28和365天的主要死亡结局进行多变量logistic回归分析。研究了130例患者。早期透析组（平均BUN 66 mg/dL）有85例患者;晚期透析组（平均BUN 137 mg/dL）有62例患者。两组的平均急性生理学和慢性健康评估II评分为24.5。总的14、28和365天生存率分别为58.1%、41.9%和23.6%。早期组在14、28和365天时的生存率分别为67%、47.7%和30.7%。晚期组在14、28和365天时的生存率分别为46.7%、31.7%和13.3%。经逻辑回归分析，开始透析时BUN > 100 mg/dL可预测14天时的死亡（比值比[OR] 3.6，95%置信区间[CI] 1.7-7.6，P=0.001），28天（OR 2.6，95% CI 1.2-5.7，P=0.01）和365天（OR 3.5，95% CI 1.2-10，P=0.02）。在这项单中心回顾性分析中，开始透析时BUN < 100 mg/dL的脓毒症患者在开始透析后1年内的死亡率有所改善。
Acute renal failure with concomitant sepsis in the intensive care unit is associated with significant mortality. The purpose of this study was to determine if the timing of initiation of renal replacement therapy (RRT) in septic patients had an effect on the 28-day mortality. Retrospective data on medical intensive care unit patients with sepsis and acute renal failure requiring RRT were included. Renal replacement therapy started with a blood urea nitrogen (BUN) of < 100 mg/dL was defined as "early" initiation, and initiation with a BUN >= 100 mg/dL was defined as "late." Multivariate logistic regression analysis with the primary outcome of death at 14, 28, and 365 days following the initiation of RRT was performed. One hundred thirty patients were studied. The early dialysis (mean BUN 66 mg/dL) group had 85 patients; the late group (mean BUN 137 mg/dL) had 62 patients. The mean acute physiology and chronic health evaluation II score was 24.5 in both groups. The overall 14, 28, and 365-day survival rates were 58.1%, 41.9%, and 23.6%. Survival rates for the early group were 67%, 47.7%, and 30.7% at 14, 28, and 365 days. Survival rates for the late group were 46.7%, 31.7%, and 13.3% at 14, 28, and 365 days. Upon logistic regression analysis, initiating dialysis with a BUN > 100 mg/dL predicted death at 14 days (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.7-7.6, P=0.001), 28 days (OR 2.6, 95% CI 1.2-5.7, P=0.01), and 365 days (OR 3.5, 95% CI 1.2-10, P=0.02). Septic patients who started dialysis with a BUN < 100 mg/dL had improved mortality rates up to 1 year after initiation of dialysis in this single-center, retrospective analysis.