Tujjar Omar, Belloni Ilaria, Hougardy Jean-Michel, Scolletta Sabino, Vincent Jean-Louis, Creteur Jacques, Taccone Fabio S
Departments of *Intensive Care †Nephrology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
J Neurosurg Anesthesiol. 2017 Apr;29(2):140-149. doi: 10.1097/ANA.0000000000000270.
Acute kidney injury (AKI) is common in critically ill patients and may contribute to poor outcome. Few data are available on the incidence and impact of AKI in patients suffering from nontraumatic subarachnoid hemorrhage (SAH).
We reviewed all patients admitted to our Department of Intensive Care with SAH over a 3-year period. Exclusion criteria were time from SAH symptoms to intensive care unit (ICU) admission >96 hours and ICU stay <48 hours. AKI was defined as sustained oligoanuria (urine output <0.5 mL/kg/h for 24 h) or an increase in plasma creatinine (≥0.3 mg/dL or a 1.5-fold increase from baseline level within 48 h). Neurological status was assessed at day 28 using the Glasgow Outcome Scale (GOS) (from 1=death to 5=good recovery; favorable outcome=GOS 4 to 5).
Of 243 patients admitted for SAH during the study period, 202 met the inclusion/exclusion criteria (median age 56 y, 78 male). Twenty-five patients (12%) developed AKI, a median of 8 (4 to 10) days after admission. Independent predictors of AKI were development of clinical vasospasm, and treatment with vancomycin. AKI was more frequent in ICU nonsurvivors than in survivors (11/50 vs. 14/152, P=0.03), and in patients with an unfavorable neurological outcome than in other patients (17/93 vs. 8/109, P=0.03). Nevertheless, in multivariable regression analysis, AKI was not an independent predictor of outcome.
AKI occurred in >10% of patients after SAH. These patients had more severe neurological impairment and needed more aggressive ICU therapy; AKI did not significantly influence outcome.
急性肾损伤（AKI）在危重症患者中很常见，且可能导致不良预后。关于非创伤性蛛网膜下腔出血（SAH）患者中AKI的发病率及影响的数据较少。
我们回顾了3年间收入我院重症监护科的所有SAH患者。排除标准为SAH症状出现至入住重症监护病房（ICU）的时间>96小时以及在ICU的停留时间<48小时。AKI定义为持续性少尿（尿量<0.5 mL/kg/h达24小时）或血浆肌酐升高（≥0.3 mg/dL或48小时内较基线水平升高1.5倍）。在第28天使用格拉斯哥预后评分（GOS）评估神经功能状态（从1=死亡至5=良好恢复；良好预后=GOS 4至5）。
在研究期间收治的243例SAH患者中，202例符合纳入/排除标准（中位年龄56岁，男性78例）。25例患者（12%）发生AKI，中位发生时间为入院后8（4至10）天。AKI的独立预测因素为临床血管痉挛的发生以及万古霉素治疗。AKI在ICU非幸存者中比幸存者更常见（11/50对14/152，P=0.03），在神经功能预后不良的患者中比其他患者更常见（17/93对8/109，P=0.03）。然而，在多变量回归分析中，AKI并非预后的独立预测因素。
SAH后超过10%的患者发生AKI。这些患者有更严重的神经功能损害，需要更积极的ICU治疗；AKI并未显著影响预后。
