Domanovits H, Müllner M, Sterz F, Schillinger M, Klösch C, Paulis M, Hirschl M M, Laggner A N
Department of Emergency Medicine, Vienna General Hospital, University of Vienna, Austria.
Wien Klin Wochenschr. 2000 Feb 25;112(4):157-61.
To assess frequency, determinants, and impact on outcome of impaired renal function in cardiac arrest survivors.
In a retrospective analysis 87 patients admitted after cardiac arrest to an emergency department between 1 March 1994 and 31 October 1995 were evaluated; patients were followed until 31 December 1998 or death. Serum creatinine was measured on arrival, 24 hours, 3 and 7 days after cardiac arrest. Impaired renal function was subclassified according to severity differentiating in between cases with an elevation of serum creatinine level > 1.4 mg/dl to 2 mg/dl and > 2 mg/dl. We examined the association between prearrest history and CPR data, collected according to the "Utstein Style", and renal function.
Patients were followed for a median of 1199 days (IQR 16 to 1427). Impaired renal function (serum creatinine level > 1.4 mg/dl) was found on admission in 36 patients (41%), at 24 hours in 24 (31%), at 3 days in 13 (19%) and on day seven in 9 patients (16%) respectively. History of congestive heart failure and duration of low flow state (from the beginning of basic and/or advanced life support until restoration of spontaneous circulation) were significantly associated with elevated serum creatinine (> 1.4 mg/dl) at 24 hours after the event. The occurrence of impaired renal function was also more frequent in patients with diabetes mellitus and hypertension, but this did not reach statistical significance. The relative risk for death was 2.8 (95% confidence interval 1.3-5.8) for a serum creatinine level of > 1.4 mg/dl to 2.0 mg/dl and 5.4 (95% confidence interval 2.4-12.1) for values > 2 mg/dl.
Transient impaired renal function is common in patients surviving cardiac arrest. Congestive heart failure and low flow time are independent predictors for the development of impaired renal function. There is a positive association in between increased serum creatinine levels and risk of death.
评估心脏骤停幸存者肾功能受损的发生率、决定因素及其对预后的影响。
对1994年3月1日至1995年10月31日期间因心脏骤停入住急诊科的87例患者进行回顾性分析；对患者随访至1998年12月31日或死亡。在心脏骤停后到达时、24小时、3天和7天测量血清肌酐。根据血清肌酐水平升高至>1.4mg/dl至2mg/dl以及>2mg/dl的情况，将肾功能受损按严重程度进行亚分类。我们研究了根据“乌斯坦模式”收集的心脏骤停前病史和心肺复苏数据与肾功能之间的关联。
患者的中位随访时间为1199天（四分位间距16至1427天）。入院时36例患者（41%）出现肾功能受损（血清肌酐水平>1.4mg/dl），24小时时24例（31%），3天时13例（19%），第7天时9例（16%）。充血性心力衰竭病史和低流量状态持续时间（从基础和/或高级生命支持开始至自主循环恢复）与事件发生后24小时血清肌酐升高（>1.4mg/dl）显著相关。糖尿病和高血压患者肾功能受损的发生率也更高，但未达到统计学意义。血清肌酐水平>1.4mg/dl至2.0mg/dl时死亡的相对风险为2.8（95%置信区间1.3 - 5.8），>2mg/dl时为5.4（95%置信区间2.4 - 12.1）。
心脏骤停幸存者中短暂性肾功能受损很常见。充血性心力衰竭和低流量时间是肾功能受损发生的独立预测因素。血清肌酐水平升高与死亡风险之间存在正相关。
