危重症及创伤患者短期肌酐清除率测定对预测24小时肌酐清除率的准确性

Accuracy of short-duration creatinine clearance determinations in predicting 24-hour creatinine clearance in critically ill and injured patients.

作者信息

Cherry Robert A, Eachempati Soumitra R, Hydo Lynn, Barie Philip S

机构信息

Department of Surgery, Lincoln Medical and Mental Health Center, Bronx, New York, USA.

出版信息

J Trauma. 2002 Aug;53(2):267-71. doi: 10.1097/00005373-200208000-00013.

DOI:10.1097/00005373-200208000-00013

PMID:12169932

Abstract

BACKGROUND

We hypothesized that measured 2-hour (CrCl2), 6-hour (CrCl6), and 16-hour (CrCl16) urine creatinine clearance accurately reflect measured (CrCl24meas) and calculated 24-hour CrCl (CrCl24calc) in critical illness.

METHODS

Urine was collected in consecutive specimens from 7 am to 9 am (CrCl2), 9 am to 3 pm (CrCl6), and 3 pm to 7 am (CrCl16) at surgical intensive care unit admission and weekly thereafter. CrCl2 and CrCl6 were added to obtain CrCl8, which was then added to CrCl16 to obtain CrCl24meas. CrCl24calc was estimated using the Cockcroft-Gault equation.

RESULTS

One hundred patients (45 with trauma) had 131 sets of CrCl2, CrCl6, and CrCl16. Trauma patients were younger; had a lower mean body surface area; and had higher CrCl2, CrCl6, and CrCl16 (all p < 0.0001). Correlation percentages (r2) comparing CrCl2, CrCl6, CrCl8, CrCl16, and CrCl24calc with CrCl24meas in trauma patients were 0.597, 0.760, 0.815, 0.958, and 0.670, respectively. In nontrauma patients, r2 values were 0.516, 0.693, 0.807, 0.946, and 0.649, respectively.

CONCLUSION

CrCl2, CrCl6, and CrCl24calc are unreliable for clinical decision making. A minimum collection period of at least 8 hours is recommended for determination of urine creatinine clearance.

摘要

背景

我们假设，在危重病中，测量的2小时（CrCl2）、6小时（CrCl6）和16小时（CrCl16）尿肌酐清除率能准确反映测量的24小时CrCl（CrCl24meas）和计算的24小时CrCl（CrCl24calc）。

方法

在外科重症监护病房入院时及之后每周，于上午7点至9点（CrCl2）、上午9点至下午3点（CrCl6）和下午3点至上午7点（CrCl16）连续采集尿液标本。将CrCl2和CrCl6相加得到CrCl8，然后将CrCl8与CrCl16相加得到CrCl24meas。使用Cockcroft-Gault方程估算CrCl24calc。

结果

100例患者（45例创伤患者）有131组CrCl2、CrCl6和CrCl16数据。创伤患者更年轻；平均体表面积更低；CrCl2、CrCl6和CrCl16更高（所有p<0.0001）。创伤患者中，将CrCl2、CrCl6、CrCl8、CrCl16和CrCl24calc与CrCl24meas进行比较的相关系数（r2）分别为0.597、0.760、0.815、0.958和0.670。在非创伤患者中，r2值分别为0.516、0.693、0.807、0.946和0.649。