Guirgis Faheem W, Williams Deborah J, Hale Matthew, Bajwa Abubakr A, Shujaat Adil, Patel Nisha, Kalynych Colleen J, Jones Alan E, Wears Robert L, Dodani Sunita
University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL.
University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, Jacksonville, FL.
Am J Emerg Med. 2015 Mar;33(3):439-43. doi: 10.1016/j.ajem.2014.12.013. Epub 2014 Dec 18.
Previous studies suggest a relationship between chloride-rich intravenous fluids and acute kidney injury in critically ill patients.
The aim of this study was to evaluate the relationship of intravenous fluid chloride content to kidney function in patients with severe sepsis or septic shock.
A retrospective chart review was performed to determine (1) quantity and type of bolus intravenous fluids, (2) serum creatinine (Cr) at presentation and upon discharge, and (3) need for emergent hemodialysis (HD) or renal replacement therapy (RRT). Linear regression was used for continuous outcomes, and logistic regression was used for binary outcomes and results were controlled for initial Cr. The primary outcome was change in Cr from admission to discharge. Secondary outcomes were need for HD/RRT, length of stay (LOS), mortality, and organ dysfunction.
There were 95 patients included in the final analysis; 48% (46) of patients presented with acute kidney injury, 8% (8) required first-time HD or RRT, 61% (58) were culture positive, 55% (52) were in shock, and overall mortality was 20% (19). There was no significant relationship between quantity of chloride administered in the first 24 hours with change in Cr (β = -0.0001, t = -0.86, R(2) = 0.92, P = .39), need for HD or RRT (odds ratio [OR] = 0.999; 95% confidence interval [CI], 0.999-1.000; P = .77), LOS >14 days (OR = 1.000; 95% CI, 0.999-1.000; P = .68), mortality (OR = 0.999; 95% CI, 0.999-1.000; P = .88), or any type of organ dysfunction.
Chloride administered in the first 24 hours did not influence kidney function in this cohort with severe sepsis or septic shock.
既往研究提示，含氯静脉输液与危重症患者急性肾损伤之间存在关联。
本研究旨在评估严重脓毒症或脓毒性休克患者静脉输液中氯含量与肾功能的关系。
进行一项回顾性病历审查，以确定：（1）静脉推注液体的量和类型；（2）入院时及出院时的血清肌酐（Cr）水平；（3）是否需要紧急血液透析（HD）或肾脏替代治疗（RRT）。连续变量采用线性回归分析，二元变量采用逻辑回归分析，结果均对初始Cr水平进行校正。主要结局指标为入院至出院时Cr的变化。次要结局指标包括是否需要HD/RRT、住院时间（LOS）、死亡率及器官功能障碍。
最终纳入分析95例患者；48%（46例）患者出现急性肾损伤，8%（8例）患者首次需要HD或RRT，61%（58例）患者血培养阳性，55%（52例）患者出现休克，总体死亡率为20%（19例）。最初24小时内给予氯的量与Cr变化（β = -0.0001，t = -0.86，R² = 0.92，P = 0.39）、是否需要HD或RRT（比值比[OR] = 0.999；95%置信区间[CI]，0.999 - 1.000；P = 0.77）、住院时间>14天（OR = 1.000；95% CI，0.999 - 1.000；P = 0.68）、死亡率（OR = 0.999；95% CI，0.999 - 1.000；P = 0.88）或任何类型的器官功能障碍均无显著相关性。
在本严重脓毒症或脓毒性休克队列中，最初24小时内给予的氯未影响肾功能。
