Zhang Zhongheng, Xu Xiao, Ni Hongying, Deng Hongsheng
Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, 351#, Mingyue Road, Jinhua, 321000, Zhejiang, People's Republic of China,
J Nephrol. 2014 Feb;27(1):65-71. doi: 10.1007/s40620-013-0024-1. Epub 2014 Jan 15.
Urine output (UO) is routinely measured in the intensive care unit (ICU) but its prognostic value remains debated. The study aimed to investigate the association between day 1 UO and hospital mortality.
Clinical data were abstracted from the Multiparameter Intelligent Monitoring in Intensive Care II (version 2.6) database. UO was recorded for the first 24 h after ICU entry, and was classified into three categories: UO >0.5, 0.3-0.5 and ≤0.3 ml/kg per hour. The primary endpoint was the hospital mortality. Four models were built to adjust for the hazards ratio of mortality.
A total of 21,207 unselected ICU patients including 2,401 non-survivors and 18,806 survivors were included (mortality rate 11.3 %). Mortality rate increased progressively across UO categories: >0.5 (7.67 %), 0.3-0.5 (11.27 %) and ≤0.3 ml/kg/h (18.29 %), and this relationship remained statistically significant after rigorous control of confounding factors with the Cox proportional hazards regression model. With UO >0.5 as the referent group, the hazards ratios for UO 0.3-0.5 and UO ≤0.3 were 1.41 (95 % CI 1.29-1.54) and 1.52 (95 % CI 1.38-1.67), respectively.
UO obtained on ICU entry is an independent predictor of mortality irrespective of diuretic use. It would be interesting to examine whether strategies to increase UO would improve clinical outcome.
尿量（UO）在重症监护病房（ICU）中是常规测量指标，但其预后价值仍存在争议。本研究旨在探讨入住ICU第1天的尿量与医院死亡率之间的关联。
临床数据取自重症监护多参数智能监测II（版本2.6）数据库。记录患者入住ICU后最初24小时的尿量，并分为三类：尿量>0.5、0.3 - 0.5和≤0.3 ml/kg每小时。主要终点为医院死亡率。构建了四个模型以调整死亡率的风险比。
共纳入21207例未经筛选的ICU患者，其中包括2401例非幸存者和18806例幸存者（死亡率11.3%）。死亡率在不同尿量类别中逐渐升高：>0.5（7.67%）、0.3 - 0.5（11.27%）和≤0.3 ml/kg/h（18.29%），在使用Cox比例风险回归模型严格控制混杂因素后，这种关系仍具有统计学意义。以尿量>0.5作为参照组，尿量0.3 - 0.5和尿量≤0.3的风险比分别为1.41（95%可信区间1.29 - 1.54）和1.52（95%可信区间1.38 - 1.67）。
入住ICU时的尿量是死亡率的独立预测因素，与是否使用利尿剂无关。探讨增加尿量的策略是否能改善临床结局将是很有意义的。
