Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
ASAIO J. 2010 Jul-Aug;56(4):333-7. doi: 10.1097/MAT.0b013e3181de35e4.
Fluid overload is a frequent finding in critically ill patients suffering from acute kidney injury (AKI). To assess the impact of fluid overload on the mortality of AKI patients treated with continuous renal replacement therapy (CRRT), we used a registry of 81 critically ill patients with AKI initiated on CRRT assembled over an 18-month period to conduct a cross- sectional analysis using volume-related weight gain (VRWG) of > or =10% and > or =20% of body weight and oliguria (< or =20 ml/h) as the principal variables, with the primary outcome measure being mortality at 30 days. Mean Apache II scores were 27.5 +/- 6.9 with overall cohort mortality of 50.6%. Mean (+/-SD) VRWG was 8.3 +/- 9.6 kg, representing a 10.2% +/- 13.5% increase since admission. Oliguria was present in 65.4% of patients. Odds ratio (OR) for mortality on univariate analysis was increased to 2.62 [95% confidence interval (CI): 1.07-6.44] by a VRWG > or =10% and to 3.22 (95% CI: 1.23-8.45) by oliguria. VRWG > or =20% had OR of 3.98 (95% CI: 1.01-15.75; p = 0.049) for mortality. Both VRWG > or =10% (OR 2.71, p = 0.040) and oliguria (OR 3.04, p = 0.032) maintained their statistically significant association with mortality in multivariate models that included sepsis and Apache II score. In conclusion, fluid overload is an important prognostic factor for survival in critically ill AKI patients treated with CRRT. Further studies are needed to elicit mechanisms and develop appropriate interventions.
液体超负荷是急性肾损伤（AKI）危重症患者的常见表现。为了评估液体超负荷对接受连续性肾脏替代治疗（CRRT）的 AKI 患者死亡率的影响，我们使用了一个在 18 个月期间收集的 81 例 AKI 危重症患者的登记数据，进行了一项横断面分析，使用体重相关的体重增加（VRWG）>或=10%和>或=20%以及少尿（<或=20ml/h）作为主要变量，主要终点为 30 天死亡率。平均 Apache II 评分为 27.5 +/- 6.9，总体死亡率为 50.6%。平均（+/-SD）VRWG 为 8.3 +/- 9.6kg，与入院时相比增加了 10.2% +/- 13.5%。65.4%的患者存在少尿。单因素分析中，VRWG >或=10%的死亡率比值比（OR）增加到 2.62（95%可信区间[CI]：1.07-6.44），少尿的 OR 增加到 3.22（95% CI：1.23-8.45）。VRWG >或=20%的死亡率 OR 为 3.98（95% CI：1.01-15.75；p=0.049）。VRWG >或=10%（OR 2.71，p=0.040）和少尿（OR 3.04，p=0.032）在包括脓毒症和 Apache II 评分的多因素模型中，与死亡率仍有统计学显著相关性。总之，液体超负荷是接受 CRRT 治疗的危重症 AKI 患者生存的一个重要预后因素。需要进一步研究以阐明机制并开发适当的干预措施。
