高氯血症与蛛网膜下腔出血患者的急性肾损伤相关。

Hyperchloremia Is Associated With Acute Kidney Injury in Patients With Subarachnoid Hemorrhage.

机构信息

1Department of Neurology and Neurosurgery, Emory University School of Medicine and Emory University Hospital, Atlanta, GA.2Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ.3Department of Anesthesiology, Penn State College of Medicine, Hershey, PA.4Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, PA.

出版信息

Crit Care Med. 2017 Aug;45(8):1382-1388. doi: 10.1097/CCM.0000000000002497.

DOI:10.1097/CCM.0000000000002497

PMID:28504980

Abstract

OBJECTIVE

To assess the prevalence of acute kidney injury in patients with subarachnoid hemorrhage patients.

DESIGN

Retrospective analysis of all subarachnoid hemorrhage admissions.

SETTINGS

Neurocritical care unit.

PATIENTS

All patients with a diagnosis of subarachnoid hemorrhage between 2009 and 2014.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Of 1,267 patients included in this cohort, 16.7% developed acute kidney injury, as defined by Kidney Disease Improving Global Outcome criteria (changes in creatinine only). Compared to patients without acute kidney injury, patients with acute kidney injury had a higher prevalence of diabetes mellitus (21.2% vs 9.8%; p < 0.001) and hypertension (70.3% vs 50.5%; p < 0.001) and presented with higher admission creatinine concentrations (1.21 ± 0.09 vs 0.81 ± 0.01 mg/dL [mean ± SD], respectively; p < 0.001). Patients with acute kidney injury also had higher mean serum chloride and sodium concentrations during their ICU stay (113.4 ± 0.6 vs 107.1 ± 0.2 mmol/L and 143.3 ± 0.4 vs 138.8 ± 0.1 mmol/L, respectively; p < 0.001 for both), but similar chloride exposure. The mortality rate was also significantly higher in patients with acute kidney injury (28.3% vs 6.1% in the non-acute kidney injury group [p < 0.001]). Logistic regression analysis revealed that only male gender (odds ratio, 1.82; 95% CI, 1.28-2.59), hypertension (odds ratio, 1.64; 95% CI, 1.11-2.43), diabetes mellitus (odds ratio, 1.88; 95% CI, 1.19-2.99), abnormal baseline creatinine (odds ratio, 2.48; 95% CI, 1.59-3.88), and increase in mean serum chloride concentration (per 10 mmol/L; odds ratio, 7.39; 95% CI, 3.44-18.23), but not sodium, were associated with development of acute kidney injury. Kidney recovery was noted in 78.8% of the cases. Recovery reduced mortality compared to non-recovering subgroup (18.6% and 64.4%, respectively; p < 0.001).

CONCLUSIONS

Critically ill patients with subarachnoid hemorrhage show a strong association between hyperchloremia and acute kidney injury as well as acute kidney injury and mortality.

摘要

目的

评估蛛网膜下腔出血患者急性肾损伤的发生率。

设计

对所有蛛网膜下腔出血患者的回顾性分析。

地点

神经重症监护病房。

患者

2009 年至 2014 年期间所有蛛网膜下腔出血患者。

干预措施

无。

测量和主要结果

本队列共纳入 1267 例患者，其中 16.7%（根据肾脏病改善全球结局标准定义）发生急性肾损伤（仅肌酐变化）。与无急性肾损伤的患者相比，有急性肾损伤的患者糖尿病（21.2% vs 9.8%；p<0.001）和高血压（70.3% vs 50.5%；p<0.001）的患病率更高，入院时肌酐浓度更高（分别为 1.21±0.09 与 0.81±0.01mg/dL[均值±标准差]；p<0.001）。急性肾损伤患者在 ICU 期间的平均血清氯和钠浓度也更高（分别为 113.4±0.6 与 107.1±0.2mmol/L 和 143.3±0.4 与 138.8±0.1mmol/L；p<0.001），但氯暴露相似。急性肾损伤患者的死亡率也显著更高（急性肾损伤组为 28.3%，非急性肾损伤组为 6.1%[p<0.001]）。Logistic 回归分析显示，只有男性（优势比，1.82；95%可信区间，1.28-2.59）、高血压（优势比，1.64；95%可信区间，1.11-2.43）、糖尿病（优势比，1.88；95%可信区间，1.19-2.99）、基线肌酐异常（优势比，2.48；95%可信区间，1.59-3.88）和平均血清氯浓度升高（每 10mmol/L；优势比，7.39；95%可信区间，3.44-18.23）与急性肾损伤的发生相关，而钠与急性肾损伤的发生无关。78.8%的病例出现了肾功能恢复。与未恢复亚组相比，恢复组的死亡率更低（分别为 18.6%和 64.4%；p<0.001）。