Perez-Valdivieso Jose Ramon, Bes-Rastrollo Maira, Monedero Pablo, de Irala Jokin, Lavilla Francisco Javier
Department of Anesthesia and Critical Care, Clinica Universitaria, University of Navarra, Pamplona, Spain.
BMC Nephrol. 2007 Sep 26;8:14. doi: 10.1186/1471-2369-8-14.
The aim of this study is to evaluate the association between acute serum creatinine changes in acute renal failure (ARF), before specialized treatment begins, and in-hospital mortality, recovery of renal function, and overall mortality at 6 months, on an equal degree of ARF severity, using the RIFLE criteria, and comorbid illnesses.
Prospective cohort study of 1008 consecutive patients who had been diagnosed as having ARF, and had been admitted in an university-affiliated hospital over 10 years. Demographic, clinical information and outcomes were measured. After that, 646 patients who had presented enough increment in serum creatinine to qualify for the RIFLE criteria were included for subsequent analysis. The population was divided into two groups using the median serum creatinine change (101%) as the cut-off value. Multivariate non-conditional logistic and linear regression models were used.
A >or= 101% increment of creatinine respect to its baseline before nephrology consultation was associated with significant increase of in-hospital mortality (35.6% vs. 22.6%, p < 0.001), with an adjusted odds ratio of 1.81 (95% CI: 1.08-3.03). Patients who required continuous renal replacement therapy in the >or= 101% increment group presented a higher increase of in-hospital mortality (62.7% vs 46.4%, p = 0.048), with an adjusted odds ratio of 2.66 (95% CI: 1.00-7.21). Patients in the >or= 101% increment group had a higher mean serum creatinine level with respect to their baseline level (114.72% vs. 37.96%) at hospital discharge. This was an adjusted 48.92% (95% CI: 13.05-84.79) more serum creatinine than in the < 101% increment group.
In this cohort, patients who had presented an increment in serum level of creatinine of >or= 101% with respect to basal values, at the time of nephrology consultation, had increased mortality rates and were discharged from hospital with a more deteriorated renal function than those with similar Liano scoring and the same RIFLE classes, but with a < 101% increment. This finding may provide more information about the factors involved in the prognosis of ARF. Furthermore, the calculation of relative serum creatinine increase could be used as a practical tool to identify those patients at risk, and that would benefit from an intensive therapy.
本研究旨在使用RIFLE标准和共病情况，在急性肾衰竭（ARF）严重程度相同的情况下，评估在开始专科治疗前急性血清肌酐变化与住院死亡率、肾功能恢复以及6个月时的总死亡率之间的关联。
对1008例连续诊断为ARF且在一所大学附属医院住院超过10年的患者进行前瞻性队列研究。测量人口统计学、临床信息和结局。之后，纳入646例血清肌酐有足够升高符合RIFLE标准的患者进行后续分析。以血清肌酐变化中位数（101%）作为临界值将人群分为两组。使用多变量非条件逻辑回归和线性回归模型。
在肾病会诊前，肌酐相对于其基线水平升高≥101%与住院死亡率显著增加相关（35.6%对22.6%，p<0.001），调整后的优势比为1.81（95%CI：1.08 - 3.03）。在升高≥101%组中需要持续肾脏替代治疗的患者住院死亡率升高幅度更大（62.7%对46.4%，p = 0.048），调整后的优势比为2.66（95%CI：1.00 - 7.21）。升高≥101%组患者出院时相对于其基线水平的平均血清肌酐水平更高（114.72%对37.96%）。这比升高<101%组调整后的血清肌酐水平高48.92%（95%CI：13.05 - 84.79）。
在该队列中，在肾病会诊时血清肌酐水平相对于基础值升高≥101%的患者，与具有相似Liano评分和相同RIFLE分级但升高<101%的患者相比，死亡率增加，出院时肾功能更差。这一发现可能为ARF预后相关因素提供更多信息。此外，计算血清肌酐相对升高可作为识别有风险患者的实用工具，这些患者将从强化治疗中获益。
