Boddi Maria, Bonizzoli Manuela, Chiostri Marco, Begliomini Dario, Molinaro Adele, Tadini Buoninsegni Laura, Gensini Gian Franco, Peris Adriano
Experimental and Clinical Medicine Department, University of Florence, Florence, Italy.
Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Florence, Italy.
Eur J Clin Invest. 2016 Mar;46(3):242-51. doi: 10.1111/eci.12590.
The predictive role of Doppler Renal Resistive Index (RRI) for mortality was shown in chronic kidney disease. In selected populations of intensive care unit (ICU), RRI predicts acute kidney injury (AKI) occurrence and anticipates persistent AKI. No data are available about mortality. We investigated whether RRI assay at AKI diagnosis could predict AKI mortality in a 10-bed-mixed medical-surgical and trauma ICU of a tertiary referral teaching hospital. The association between RRI and persistent AKI at discharge was investigated.
One hundred and twenty-five of 1512 patients admitted from January 2010 to March 2013 who developed AKI during ICU stay were enrolled. Kidney function was evaluated daily according to risk, injury, failure, loss and end-stage criteria. At AKI diagnosis, we measured RRI. The association between RRI at AKI diagnosis and ICU death or persistent AKI at ICU discharge was analysed by multivariable logistic regression analysis.
At AKI diagnosis, RRI was 0·77 (0·70-0·88) in survivors and 0·85 in nonsurvivors (0·79-0·94) (P = 0·002). RRI values were significantly associated with ICU death (OR = 1·63-95% CI 1·06-2·49, P = 0·025). A RRI cut-off value of 0·77 was identified by receiver operating characteristic curve. Multivariate analysis selected RRI and abdominal hypertension as strongest predictors of AKI mortality. At AKI diagnosis, RRI was 0·78 (0·70-0·85) or 0·85 (0·73-0·92) (P = 0·026) in patients with or without persistent AKI at discharge. Multivariate analysis selected RRI at AKI diagnosis as the strongest predictor of persistent AKI.
High RRI values at AKI diagnosis are strictly and independently associated with in-ICU mortality and persistent AKI at ICU discharge.
在慢性肾脏病中，已证实多普勒肾阻力指数（RRI）对死亡率具有预测作用。在重症监护病房（ICU）的特定人群中，RRI可预测急性肾损伤（AKI）的发生并预判持续性AKI。但尚无关于死亡率的数据。我们调查了在一家三级转诊教学医院的10张床位的内科-外科及创伤混合ICU中，AKI诊断时的RRI检测是否能预测AKI死亡率。同时研究了RRI与出院时持续性AKI之间的关联。
纳入2010年1月至2013年3月期间入住ICU且在住院期间发生AKI的1512例患者中的125例。根据风险、损伤、衰竭、丧失和终末期标准每日评估肾功能。在AKI诊断时，测量RRI。通过多变量逻辑回归分析来分析AKI诊断时的RRI与ICU死亡或ICU出院时持续性AKI之间的关联。
在AKI诊断时，存活患者的RRI为0.77（0.70 - 0.88），非存活患者为0.85（0.79 - 0.94）（P = 0.002）。RRI值与ICU死亡显著相关（OR = 1.63 - 95% CI 1.06 - 2.49，P = 0.025）。通过受试者工作特征曲线确定RRI的截断值为0.77。多变量分析选择RRI和腹腔高压作为AKI死亡率的最强预测因素。在AKI诊断时，出院时有或无持续性AKI的患者的RRI分别为0.78（0.70 - 0.85）或0.85（0.73 - 0.92）（P = 0.026）。多变量分析选择AKI诊断时的RRI作为持续性AKI的最强预测因素。
AKI诊断时较高的RRI值与ICU内死亡率及ICU出院时的持续性AKI密切且独立相关。
