Dass Bhagwan, Shimada Michiko, Kambhampati Ganesh, Ejaz Noel I, Arif Amir A, Ejaz Abutaleb A
Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL, USA.
Clin Nephrol. 2012 Jun;77(6):438-44. doi: 10.5414/cn107278.
We hypothesized that positive fluid balance (FB) is the result of intraoperative kidney injury and associated renal vasoconstriction, and therefore may be an early clinical indicator of acute kidney injury (AKI). Since rapid changes in fluid volume occur during cardiovascular (CV) surgery, we investigated the influence of immediate postoperative FB on AKI.
Data from the Nesiritide Study were retrospectively analyzed to investigate the association between FB and AKI.
Patients were classified into a negative FB (NegFB, median -1,221 ml, IQR -1,974 to -653 ml, n = 71) and a PosFB (median 849 ml, IQR 328 - 1,552 ml, n = 19) group based on FB status in the first 24 h postoperatively. The PosFB group had a higher incidence of AKI (NegFB 25.3% vs. PosFB 47.3%, p = 0.090) compared to the NegFB group. The difference in the incidence of AKI was significantly higher (NegFB 25.3% vs. high- PosFB 80%, p = 0.001) in the subset of patients who had FB ≥ 849 ml (highPosFB, n = 10). The highPosFB group demonstrated a significantly elevated risk for AKI in both unadjusted (OR = 9.8, 95% CI 1.9 - 51.2, p = 0.007) and multivariate models (OR = 8.1, 95% CI 1.5 - 45.1, p = 0.03).
PosFB in the immediate postoperative period may be an independent early indicator of AKI in patients undergoing CV surgery.
我们推测正液体平衡（FB）是术中肾损伤及相关肾血管收缩的结果，因此可能是急性肾损伤（AKI）的早期临床指标。由于心血管（CV）手术期间液体量会快速变化，我们研究了术后即刻FB对AKI的影响。
对奈西立肽研究的数据进行回顾性分析，以研究FB与AKI之间的关联。
根据术后24小时内的FB状态，将患者分为负液体平衡组（NegFB，中位数-1221ml，四分位间距-1974至-653ml，n = 71）和正液体平衡组（PosFB，中位数849ml，四分位间距328 - 1552ml，n = 19）。与NegFB组相比，PosFB组的AKI发生率更高（NegFB组为25.3%，PosFB组为47.3%，p = 0.090）。在FB≥849ml的患者亚组（高PosFB组，n = 10）中，AKI发生率的差异显著更高（NegFB组为25.3%，高PosFB组为80%，p = 0.001）。高PosFB组在未校正模型（OR = 9.8，95%CI 1.9 - 51.2，p = 0.007）和多变量模型（OR = 8.1，95%CI 1.5 - 45.1，p = 0.03）中均显示出AKI风险显著升高。
术后即刻的正液体平衡可能是CV手术患者AKI的独立早期指标。
