*Servicio Médico Integral, Montevideo, Uruguay†Hospital Español, Montevideo, Uruguay‡Hospital Universitario de Getafe, Madrid, Spain§CIBER Enfermedades Respiratorias, Barcelona, Spain||Hospital de Clínicas, Universidad de la Republica, Montevideo, Uruguay¶Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina#Hospital Regional 1° Octubre, ISSSTE, Ciudad de México, México, Mexico**Medizinische Hochschule Hannover, Hannover, Germany††Asan Medical Center, University of Ulsan, Seoul, Republic of Korea‡‡Clínica Medellín and Universidad Pontificia Bolivariana, Medellín, Colombia§§Hospital Fattouma Bourguina, Monastir, Tunisia||||Hospital Eugenio Espejo, Quito, Ecuador¶¶King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia##UCINC, Hospital de Sao José, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal***Papageorgiou Hospital, Thessaloniki, Greece†††South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas.
Shock. 2017 Oct;48(4):411-417. doi: 10.1097/SHK.0000000000000871.
Acute kidney injury (AKI) is a frequent complication in patients under mechanical ventilation (MV). We aimed to assess the risk factors for AKI with particular emphasis on those potentially preventable.
STUDY DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of a large, multinational database of MV patients with >24 h of MV and normal renal function at admission. AKI was defined according to creatinine-based KDIGO criteria. Risk factors were analyzed according to the time point at which AKI occurred: early (≤48 h after ICU admission, AKIE) and late (day 3 to day 7 of ICU stay, AKIL). A conditional logistic regression model was used to identify variables independently associated with AKI.
Three thousand two hundred six patients were included. Seven hundred patients had AKI (22%), the majority of them AKIE (547/704). The risk factor profile was highly dependent upon the timing of AKI onset. In AKIE risk factors were older age; SAPS II score; postoperative and cardiac arrest as the reasons for MV; worse cardiovascular SOFA, pH, serum creatinine, and platelet count; higher level of peak pressure and Vt/kg; and fluid overload at admission. In contrast, AKIL was linked mostly to events that occurred after admission (lower platelet count and pH; ICU-acquired sepsis; and fluid overload). None ventilation-associated parameters were identify as risk factors for AKIL.
In the first 48 h, risk factors are associated with the primary disease and the patient's condition at admission. Subsequently, emergent events like sepsis and organ dysfunction appear to be predictive factors making prevention a challenge.
急性肾损伤（AKI）是机械通气（MV）患者的常见并发症。我们旨在评估 AKI 的危险因素，尤其强调那些潜在可预防的因素。
研究设计、地点和参与者：对 MV 患者的大型跨国数据库进行回顾性分析，MV 持续时间超过 24 小时，入院时肾功能正常。AKI 根据基于肌酐的 KDIGO 标准定义。根据 AKI 发生的时间点分析危险因素：早期（入住 ICU 后≤48 小时，AKIE）和晚期（入住 ICU 第 3 天至第 7 天，AKIL）。使用条件逻辑回归模型确定与 AKI 独立相关的变量。
共纳入 3206 例患者。700 例患者发生 AKI（22%），其中大多数为 AKIE（547/704）。危险因素谱高度依赖于 AKI 发病的时间。AKIE 的危险因素包括年龄较大；SAPS II 评分；MV 的原因是术后和心搏骤停；心血管 SOFA、pH、血清肌酐和血小板计数更差；更高的峰压和 Vt/kg；以及入院时的液体超负荷。相比之下，AKIL 主要与入住后发生的事件有关（血小板计数和 pH 较低；ICU 获得性败血症；和液体超负荷）。没有发现与通气相关的参数是 AKIL 的危险因素。
在最初的 48 小时内，危险因素与主要疾病和入院时患者的状况有关。随后，像败血症和器官功能障碍等紧急事件似乎是预测因素，这使得预防成为挑战。
