Margolis Gilad, Kofman Natalia, Gal-Oz Amir, Arbel Yaron, Khoury Shafik, Keren Gad, Shacham Yacov
Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
J Crit Care. 2017 Aug;40:184-188. doi: 10.1016/j.jcrc.2017.04.011. Epub 2017 Apr 7.
We analyzed the relationship between a positive fluid balance and its persistence over time on acute kidney injury (AKI) development, severity and resolution among ST elevation myocardial infarction (STEMI) patients complicated by cardiogenic shock.
We retrospectively studied the cumulative fluid balance intake and output at 96h following hospital admission in 84 consecutive adult patients with STEMI complicated by cardiogenic shock. The cohort was stratified into two groups, based on the presence or absence of positive fluid balance on day 4. Patients' records were assessed for the development of AKI, AKI severity and recovery.
Patients having positive fluid balance were more likely to develop a more severe AKI stage (52% vs. 13%; p<0.001), were less likely to have recovery of their renal function (29% vs. 75%, p=0.001), and demonstrated positive correlation between the amount of fluid accumulated and the rise in serum creatinine (R=0.42, p=0.004). For every 1l increase in positive fluid balance, the adjusted possibility for recovery of renal function decreased by 21% (OR=0.796, 95% CI 0.67-0.93; p=0.006).
A positive fluid balance was strongly associated with higher stage AKI and lower rate of AKI recovery in STEMI complicated by cardiogenic shock.
我们分析了急性肾损伤（AKI）发生、严重程度及缓解情况与正液体平衡及其随时间持续性之间的关系，这些情况发生于合并心源性休克的ST段抬高型心肌梗死（STEMI）患者中。
我们回顾性研究了84例连续入院的合并心源性休克的成年STEMI患者入院96小时后的累计液体平衡入量和出量。根据第4天是否存在正液体平衡，将该队列分为两组。评估患者记录中AKI的发生情况、AKI严重程度及恢复情况。
存在正液体平衡的患者更有可能发展为更严重的AKI阶段（52%对13%；p<0.001），肾功能恢复的可能性更低（29%对75%，p=0.001），并且液体蓄积量与血清肌酐升高之间呈正相关（R=0.42，p=0.004）。正液体平衡每增加1升，肾功能恢复的校正可能性降低21%（OR=0.796，95%CI 0.67-0.93；p=0.006）。
在合并心源性休克的STEMI患者中，正液体平衡与更高阶段的AKI及更低的AKI恢复率密切相关。
