Kang Hye Ran, Lee Si Nae, Cho Yun Ju, Jeon Jin Seok, Noh Hyunjin, Han Dong Cheol, Park Suyeon, Kwon Soon Hyo
Division of Nephrology, Soonchunhyang University Hospital, Seoul, Korea.
Hyonam Kidney Laboratory, Soonchunhyang University Hospital, Seoul, Korea.
PLoS One. 2017 Aug 24;12(8):e0183156. doi: 10.1371/journal.pone.0183156. eCollection 2017.
The elevation of serum creatinine (SCr), acute kidney injury (AKI), is associated with an increase of mortality in critically ill patients. However, it is uncertain whether a decrease in SCr in the intensive care unit (ICU) has an effect on outcomes.
In a retrospective study, we enrolled 486 patients who had been admitted to an urban tertiary center ICU between Jan 2014 and Dec 2014. The effect of changes in SCr after ICU admission on 90 day mortality was analyzed. Patients were classified into 3 groups based on change in SCr after ICU admission: a stable SCr group (Δ SCr < 0.3mg/dL during ICU stay), a decreased SCr group (Δ SCr ≥ -0.3 mg/dL during ICU stay) and an increased SCr group with criteria based on the KDIGO AKI criteria.
In total, 486 patients were identified. SCr decreased in 123 (25.3%) patients after ICU admission. AKI developed in 125 (24.4%) patients. The overall 90-day mortality rate was 29.0%. In a Kaplan-Meyer analysis, the mortality of the AKI group was higher than that of other groups (p<0.0001). Patients with a decrease in SCr had a higher mortality rate than those with stable SCr (p<0.0001). A Cox analysis showed that both a decrease in SCR (HR, 3.56; 95% CI, 1.59-7.97; p = 0.002) and an increase in SCr (AKI stage 1, HR, 9.35; 95% CI, 4.18-20.9; p<0.0001; AKI stage 2, HR, 11.82; 95% CI, 3.85-36.28; p<0.0001; AKI stage 3, HR, 17.41; 95% CI, 5.50-55.04; p<0.0001) were independent risk factors for death compared to stable SCr.
Not only an increase in SCr, but also a decrease in SCr was associated with mortality in critically ill patients.
血清肌酐（SCr）升高即急性肾损伤（AKI），与危重症患者死亡率增加相关。然而，重症监护病房（ICU）内SCr降低是否会对预后产生影响尚不确定。
在一项回顾性研究中，我们纳入了2014年1月至2014年12月期间入住一家城市三级中心ICU的486例患者。分析了ICU入院后SCr变化对90天死亡率的影响。根据ICU入院后SCr的变化将患者分为3组：SCr稳定组（ICU住院期间ΔSCr<0.3mg/dL）、SCr降低组（ICU住院期间ΔSCr≥-0.3mg/dL）以及根据KDIGO急性肾损伤标准划分的SCr升高组。
共纳入486例患者。123例（25.3%）患者在ICU入院后SCr降低。125例（24.4%）患者发生了急性肾损伤。90天总死亡率为29.0%。在Kaplan-Meier分析中，急性肾损伤组的死亡率高于其他组（p<0.0001）。SCr降低的患者死亡率高于SCr稳定的患者（p<0.0001）。Cox分析显示，与SCr稳定相比，SCr降低（风险比[HR]，3.56；95%置信区间[CI]，1.59 - 7.97；p = 0.002）以及SCr升高（急性肾损伤1期，HR，9.35；95%CI，4.18 - 20.9；p<0.0001；急性肾损伤2期，HR，11.82；95%CI，3.85 - 36.28；p<0.0001；急性肾损伤3期，HR，17.41；95%CI，5.50 - 55.04；p<0.0001）均是死亡的独立危险因素。
在危重症患者中，不仅SCr升高与死亡率相关，SCr降低也与死亡率相关。
