Premuzic Vedran, Basic-Jukic Nikolina, Jelakovic Bojan, Kes Petar
Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia.
J Artif Organs. 2017 Dec;20(4):326-334. doi: 10.1007/s10047-017-0970-9. Epub 2017 Jul 4.
We hypothesized that patients with sepsis and AKI, especially patients without preserved renal function, and treated with continuous veno-venous hemodiafiltration (CVVHDF), have lower risk for mortality than patients treated with continuous veno-venous hemofiltration (CVVH). Patients were included if they fulfilled the diagnosis of severe sepsis or septic shock, suffered AKI and received continuous renal replacement therapy (CRRT) in intensive care unit. There were 62 patients treated by CVVH and 75 treated by CVVHDF. Mean survival time was longer in CVVHDF group with oliguric/anuric patients than in CVVH group. CVVH, and not classic risk factors, was associated with higher overall mortality in oliguric/anuric patients. In the linear regression model, hourly urine output was the strongest and positive predictor of longer survival. CVVHDF is according to our results a CRRT modality of choice for the treatment and lower mortality of septic patients with AKI where renal function is no longer preserved. CRRT has been associated with improved renal recovery, but it should be started earlier in AKI evolution with still preserved hourly urine output which is the most sensitive and prognostic marker of survival in septic patients with AKI.
我们假设，脓毒症和急性肾损伤患者，尤其是肾功能未保留且接受持续静脉-静脉血液透析滤过（CVVHDF）治疗的患者，其死亡风险低于接受持续静脉-静脉血液滤过（CVVH）治疗的患者。如果患者符合严重脓毒症或脓毒性休克的诊断标准，患有急性肾损伤并在重症监护病房接受持续肾脏替代治疗（CRRT），则纳入研究。共有62例患者接受CVVH治疗，75例患者接受CVVHDF治疗。在少尿/无尿患者中，CVVHDF组的平均生存时间长于CVVH组。在少尿/无尿患者中，与总体死亡率较高相关的是CVVH，而非经典危险因素。在线性回归模型中，每小时尿量是生存时间延长的最强且呈正相关的预测因素。根据我们的研究结果，CVVHDF是治疗急性肾损伤且肾功能不再保留的脓毒症患者并降低其死亡率的首选CRRT模式。CRRT与肾功能恢复改善相关，但应在急性肾损伤进展且每小时尿量仍保留时尽早开始，每小时尿量是急性肾损伤脓毒症患者生存最敏感和最具预后价值的标志物。
