非危重症腹部及创伤手术患者的肾脏清除率增加是一个被低估的现象：一项现况研究。
Augmented renal clearance in non-critically ill abdominal and trauma surgery patients is an underestimated phenomenon: A point prevalence study.
作者信息
Declercq Peter, Nijs Stefaan, DʼHoore André, Van Wijngaerden Eric, Wolthuis Albert, de Buck van Overstraeten Anthony, Wauters Joost, Spriet Isabel
机构信息
From the KU Leuven University of Leuven, Pharmacy Department (P.D., I.S.), University Hospitals Leuven & Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium; KU Leuven University of Leuven, Department of Traumatology (S.N.), Faculty of Medicine, University Hospitals Leuven, Leuven, Belgium; KU Leuven University of Leuven, Department of Abdominal Surgery (A.d'H., A.W., A.d.B.v.O.), Faculty of Medicine, University Hospitals Leuven, Leuven, Belgium; KU Leuven University of Leuven, Department of Internal Medicine (E.V.W., J.W.), Faculty of Medicine, University Hospitals Leuven, Leuven, Belgium.
出版信息
J Trauma Acute Care Surg. 2016 Sep;81(3):468-77. doi: 10.1097/TA.0000000000001138.
BACKGROUND
Augmented renal clearance refers to increased renal elimination of circulating solutes as compared with normal baseline and could lead to underexposure of frequently used renally eliminated antimicrobials. The primary objective was to assess the prevalence of augmented renal clearance in an adult non-critically ill surgery population. Besides, predictors for augmented renal clearance were investigated. A prospective observational single-center point prevalence study was conducted.
METHODS
The measured creatinine clearance based on an 8-hour urinary collection was used as primary method for determining kidney function. Augmented renal clearance was defined as measured creatinine clearance of 130 mL/min per 1.73m² or greater. A Poisson regression model was applied to identify predictors for augmented renal clearance.
RESULTS
Augmented renal clearance prevalence was 30% and 35% in 103 abdominal and 129 trauma surgery patients, respectively. Younger age (abdominal cohort: relative risk, 0.963 (95% CI, 0.949-0.978); trauma cohort: relative risk, 0.971 [95% CI, 0.960-0.983]) and also for trauma surgery patients, male sex (relative risk, 1.808 [95% CI, 1.026-3.185]) were found to be independent predictors for augmented renal clearance.
CONCLUSIONS
Augmented renal clearance is an underestimated phenomenon in adult non-critically ill surgery patients. Especially younger patients, and, in the subset of trauma surgery, males are prone to exhibit augmented renal clearance. Since augmented renal clearance is a risk factor for lower antimicrobial exposure, the impact of augmented renal clearance in relation to antimicrobial underexposure should be investigated in this population.
LEVEL OF EVIDENCE
Prognostic/epidemiological study, level III.
背景
与正常基线相比，肾脏清除率增加是指循环溶质的肾脏清除增加，这可能导致常用经肾脏清除的抗菌药物暴露不足。主要目的是评估成年非危重症手术人群中肾脏清除率增加的患病率。此外，还研究了肾脏清除率增加的预测因素。进行了一项前瞻性观察性单中心现况研究。
方法
基于8小时尿液收集测定的肌酐清除率被用作确定肾功能的主要方法。肾脏清除率增加定义为测定的肌酐清除率为每分钟130毫升/1.73平方米或更高。应用泊松回归模型来确定肾脏清除率增加的预测因素。
结果
103例腹部手术患者和129例创伤手术患者中，肾脏清除率增加的患病率分别为30%和35%。年龄较小（腹部队列：相对风险，0.963[95%置信区间，0.949 - 0.978]；创伤队列：相对风险，0.971[95%置信区间，0.960 - 0.983]），并且对于创伤手术患者，男性（相对风险，1.808[95%置信区间，1.026 - 3.185]）被发现是肾脏清除率增加的独立预测因素。
结论
在成年非危重症手术患者中，肾脏清除率增加是一个被低估的现象。尤其是年轻患者，并且在创伤手术亚组中，男性更容易出现肾脏清除率增加。由于肾脏清除率增加是抗菌药物暴露降低的一个危险因素，因此应在该人群中研究肾脏清除率增加与抗菌药物暴露不足的关系。
证据水平
预后/流行病学研究，III级。
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