Zhang Ling, Chen Zhiwen, Diao Yongshu, Yang Yingying, Fu Ping
Division of Nephrology, West China Hospital of Sichuan University, Sichuan, Chengdu, China.
Division of Nephrology, West China Hospital of Sichuan University, Sichuan, Chengdu, China.
J Crit Care. 2015 Aug;30(4):860.e7-13. doi: 10.1016/j.jcrc.2015.03.025. Epub 2015 Apr 9.
Fluid resuscitation is commonly administered to maintain adequate renal perfusion in critically ill patients to prevent or even treat acute kidney injury (AKI). However, recent studies show that fluid overload is common and might be associated with poor outcomes in patients with AKI. Hence, the objective of this study was to assess the associations of fluid overload with mortality and kidney recovery in patients with AKI.
We electronically searched original articles published in peer-reviewed journals from their inception to January 2015 in PubMed, EMBASE, the Cochrane Library databases, Google Scholar, and Chinese database (SinoMed). We additionally searched the reference lists of all retrieved articles. We performed a systematic review and meta-analysis of all eligible cohort or case-control studies of fluid overload in patients with AKI. The primary outcomes were mortality and kidney recovery. We pooled adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) by using Review Manager 5.2 (The Cochrane Collaboration, Oxford, UK).
A total of 5095 patients from 12 cohort studies published from 2008 to 2014 were included. A significant positive association was found between fluid overload and mortality in patients with AKI (OR, 2.23; 95% CI, 1.66-3.01), with similar findings in sepsis (OR, 2.27; 95% CI, 1.69-to 3.03) and nonsepsis subgroups (OR, 3.40; 95% CI, 2.50-4.63). There was also a significant association between mean fluid balance (continuous variables) and mortality (OR, 1.16; 95% CI, 1.07-1.27). Although there was a trend of lower rate of kidney recovery in the fluid overload group, there was no significant association between fluid overload and kidney recovery (OR, 0.66; 95% CI, 0.37-1.15), or dialysis dependence (OR, 0.72; 95% CI, 0.38-1.35).
Fluid overload is associated with an increased risk of mortality in patients with AKI. The evidence of the relationship between fluid overload and kidney recovery is insufficient.
在重症患者中，液体复苏常用于维持充足的肾灌注，以预防甚至治疗急性肾损伤（AKI）。然而，近期研究表明，液体超负荷情况常见，且可能与AKI患者的不良预后相关。因此，本研究旨在评估液体超负荷与AKI患者死亡率及肾脏恢复情况之间的关联。
我们通过电子检索从创刊至2015年1月发表于同行评审期刊的原始文章，检索数据库包括PubMed、EMBASE、Cochrane图书馆数据库、谷歌学术以及中文数据库（中国生物医学文献数据库）。我们还检索了所有检索到文章的参考文献列表。我们对所有符合条件的关于AKI患者液体超负荷的队列研究或病例对照研究进行了系统评价和荟萃分析。主要结局指标为死亡率和肾脏恢复情况。我们使用Review Manager 5.2（英国牛津Cochrane协作网）汇总调整后的比值比（OR）及95%置信区间（95%CI）。
纳入了2008年至2014年发表的12项队列研究中的共5095例患者。发现AKI患者中液体超负荷与死亡率之间存在显著正相关（OR = 2.23；95%CI：1.66 - 3.01），脓毒症亚组（OR = 2.27；95%CI：1.69 - 3.03）和非脓毒症亚组（OR = 3.40；CI：2.50 - 4.63）中也有类似发现。平均液体平衡（连续变量）与死亡率之间也存在显著关联（OR = 1.16；95%CI：1.07 - 1.27）。尽管液体超负荷组的肾脏恢复率有降低趋势，但液体超负荷与肾脏恢复（OR = 0.66；95%CI：0.37 - 1.15）或透析依赖（OR = 0.72；95%CI：0.38 - 1.35）之间无显著关联。
液体超负荷与AKI患者死亡风险增加相关。液体超负荷与肾脏恢复之间关系的证据不足。
