Teixeira Catarina, Garzotto Francesco, Piccinni Pasquale, Brienza Nicola, Iannuzzi Michele, Gramaticopolo Silvia, Forfori Francesco, Pelaia Paolo, Rocco Monica, Ronco Claudio, Anello Clara Belluomo, Bove Tiziana, Carlini Mauro, Michetti Vincenzo, Cruz Dinna N
Crit Care. 2013 Jan 24;17(1):R14. doi: 10.1186/cc12484.
In ICUs, both fluid overload and oliguria are common complications associated with increased mortality among critically ill patients, particularly in acute kidney injury (AKI). Although fluid overload is an expected complication of oliguria, it remains unclear whether their effects on mortality are independent of each other. The aim of this study is to evaluate the impact of both fluid balance and urine volume on outcomes and determine whether they behave as independent predictors of mortality in adult ICU patients with AKI.
We performed a secondary analysis of data from a multicenter, prospective cohort study in 10 Italian ICUs. AKI was defined by renal sequential organ failure assessment (SOFA) score (creatinine >3.5 mg/dL or urine output (UO) <500 mL/d). Oliguria was defined as a UO <500 mL/d. Mean fluid balance (MFB) and mean urine volume (MUV) were calculated as the arithmetic mean of all daily values. Use of diuretics was noted daily. To assess the impact of MFB and MUV on mortality of AKI patients, multivariate analysis was performed by Cox regression.
Of the 601 included patients, 132 had AKI during their ICU stay and the mortality in this group was 50%. Non-surviving AKI patients had higher MFB (1.31 ± 1.24 versus 0.17 ± 0.72 L/day; P <0.001) and lower MUV (1.28 ± 0.90 versus 2.35 ± 0.98 L/day; P <0.001) as compared to survivors. In the multivariate analysis, MFB (adjusted hazard ratio (HR) 1.67 per L/day, 95%CI 1.33 to 2.09; <0.001) and MUV (adjusted HR 0.47 per L/day, 95%CI 0.33 to 0.67; <0.001) remained independent risk factors for 28-day mortality after adjustment for age, gender, diabetes, hypertension, diuretic use, non-renal SOFA and sepsis. Diuretic use was associated with better survival in this population (adjusted HR 0.25, 95%CI 0.12 to 0.52; <0.001).
In this multicenter ICU study, a higher fluid balance and a lower urine volume were both important factors associated with 28-day mortality of AKI patients.
在重症监护病房（ICU）中，液体超负荷和少尿都是危重症患者死亡率增加的常见并发症，尤其是在急性肾损伤（AKI）患者中。尽管液体超负荷是少尿的预期并发症，但它们对死亡率的影响是否相互独立仍不清楚。本研究的目的是评估液体平衡和尿量对结局的影响，并确定它们是否作为成人AKI患者死亡率的独立预测因素。
我们对来自意大利10个ICU的一项多中心前瞻性队列研究的数据进行了二次分析。AKI由肾脏序贯器官衰竭评估（SOFA）评分定义（肌酐>3.5mg/dL或尿量（UO）<500mL/d）。少尿定义为UO<500mL/d。平均液体平衡（MFB）和平均尿量（MUV）计算为所有每日值的算术平均值。每天记录利尿剂的使用情况。为了评估MFB和MUV对AKI患者死亡率的影响，采用Cox回归进行多变量分析。
在纳入的601例患者中，132例在ICU住院期间发生AKI，该组的死亡率为50%。与幸存者相比，非存活的AKI患者MFB更高（1.31±1.24对0.17±0.72L/天；P<0.001），MUV更低（1.28±0.90对2.35±0.98L/天；P<0.001）。在多变量分析中，在对年龄、性别、糖尿病、高血压、利尿剂使用、非肾脏SOFA和脓毒症进行调整后，MFB（调整后风险比（HR）为每升/天1.67，95%CI为1.33至2.09；P<0.001）和MUV（调整后HR为每升/天0.47，95%CI为0.33至0.67；P<0.001）仍然是28天死亡率的独立危险因素。利尿剂的使用与该人群更好的生存率相关（调整后HR为0.25，95%CI为0.12至0.52；P<0.001）。
在这项多中心ICU研究中，较高的液体平衡和较低的尿量都是与AKI患者28天死亡率相关的重要因素。
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