Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, PR China.
Ren Fail. 2010 Jul;32(6):673-9. doi: 10.3109/0886022X.2010.486492.
We retrospectively studied a random cohort of patients with cerebral trauma to investigate the risk factors of acute kidney injury (AKI) following cerebral trauma. AKI was determined using the RIFLE (risk, injury, failure, loss, or end-stage kidney) staging criteria. About 171 patients were chosen in the study, with 53 patients in AKI group and 118 patients without AKI in non-AKI group. By logistic regression analysis, univariate analysis revealed that age, hypertension, emergent surgery, systemic inflammatory response syndrome (SIRS), Glasgow coma score (GCS), sequential organ failure assessment (SOFA) score, the respiration, coagulation, and cardiovascular components of the SOFA score, mechanical ventilation time, red blood cell transfusion, plasma transfusion, and the accumulative doses of furosemide, torsemide, and mannitol were significantly related to AKI after cerebral trauma. Logistic multivariate regression analysis showed that SOFA score [odds ratio (OR) = 1.516, 95% confidence interval (CI) 1.222-1.881, p < 0.001], the accumulative doses of torsemide (OR = 0.016, 95% CI 1.002-1.031, p = 0.016), and the accumulative doses of mannitol (OR = 2.687, 95% CI 1.062-6.800, p = 0.037) were independent risk factors of AKI. This model had a good discrimination for AKI with an area under the receiver operating characteristic (ROC) curve of 0.901 (p < 0.001). The accumulative doses of mannitol as a risk factor of AKI were identified by propensity score match (PSM) method. We concluded that AKI was a common complication in patients with cerebral trauma. SOFA score and the accumulative doses of torsemide and mannitol were independent risk factors of AKI following cerebral trauma.
我们回顾性研究了一组随机的颅脑外伤患者，以探讨颅脑外伤后急性肾损伤（AKI）的危险因素。AKI 采用 RIFLE（风险、损伤、衰竭、丧失、终末期肾病）分期标准来确定。研究中选择了约 171 例患者，其中 AKI 组 53 例，非 AKI 组 118 例。通过 logistic 回归分析，单因素分析显示，年龄、高血压、急诊手术、全身炎症反应综合征（SIRS）、格拉斯哥昏迷评分（GCS）、序贯器官衰竭评估（SOFA）评分、呼吸、凝血和心血管 SOFA 评分成分、机械通气时间、红细胞输注、血浆输注以及呋塞米、托拉塞米和甘露醇的累积剂量与颅脑外伤后 AKI 显著相关。多因素 logistic 回归分析显示，SOFA 评分[比值比（OR）=1.516，95%置信区间（CI）1.222-1.881，p<0.001]、托拉塞米累积剂量（OR=0.016，95%CI 1.002-1.031，p=0.016）和甘露醇累积剂量（OR=2.687，95%CI 1.062-6.800，p=0.037）是 AKI 的独立危险因素。该模型对 AKI 具有良好的鉴别能力，ROC 曲线下面积为 0.901（p<0.001）。采用倾向评分匹配（PSM）方法确定甘露醇累积剂量作为 AKI 的危险因素。我们得出结论，AKI 是颅脑外伤患者的常见并发症。SOFA 评分和托拉塞米及甘露醇累积剂量是颅脑外伤后 AKI 的独立危险因素。
