Canet Emmanuel, Cheminant Morgane, Zafrani Lara, Thieblemont Catherine, Galicier Lionel, Lengline Etienne, Schnell David, Reuter Danielle, Darmon Michael, Schlemmer Benoit, Azoulay Elie
Medical Intensive Care Unit.
Leuk Lymphoma. 2014 Oct;55(10):2362-7. doi: 10.3109/10428194.2013.874010. Epub 2014 Feb 24.
Acute kidney injury (AKI) is associated with high morbidity and mortality in tumor lysis syndrome (TLS). The goal of this study was to assess a practical approach involving a simple risk-prediction model for AKI in patients at high risk for clinical TLS treated according to standardized guidelines. We collected data on 62 patients at high risk for clinical TLS. We evaluated whether the magnitude of the plasma uric acid decrease in response to rasburicase predicted AKI. According to RIFLE criteria (Risk, Injury, Failure, sustained Loss, End-stage kidney disease), 41 (66.1%) patients had AKI. AKI was associated with higher hospital (26.8% vs. 0%, p = 0.01) and 6-month (41.4% vs. 9.5%, p = 0.04) mortality. The plasma uric acid decrease after rasburicase was significantly larger in patients who did not develop AKI than in those who did (95% vs. 84%; p < 0.01). By multivariate analysis, independent determinants of AKI were hypertension and a plasma uric acid decrease smaller than 92.9% 6 h after rasburicase.
急性肾损伤（AKI）与肿瘤溶解综合征（TLS）的高发病率和死亡率相关。本研究的目的是评估一种实用方法，该方法涉及对按照标准化指南治疗的临床TLS高危患者的AKI采用简单的风险预测模型。我们收集了62例临床TLS高危患者的数据。我们评估了接受拉布立酶治疗后血浆尿酸降低幅度是否可预测AKI。根据RIFLE标准（风险、损伤、衰竭、持续性丧失、终末期肾病），41例（66.1%）患者发生了AKI。AKI与更高的医院死亡率（26.8%对0%，p = 0.01）和6个月死亡率（41.4%对9.5%，p = 0.04）相关。未发生AKI的患者接受拉布立酶治疗后血浆尿酸降低幅度显著大于发生AKI的患者（95%对84%；p < 0.01）。多因素分析显示AKI的独立决定因素为高血压以及接受拉布立酶治疗6小时后血浆尿酸降低幅度小于92.9%。
