在静脉-静脉 ECMO 支持下严重急性肾衰竭的 3 个月预后影响：发病时间的重要性。
3-month prognostic impact of severe acute renal failure under veno-venous ECMO support: Importance of time of onset.
机构信息
Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France; Intensive Cardiac care, Cardiology department, Rangueil University Hospital, 1 Av Jean-Poulhes, 31059 Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, INSERM 1048, Rangueil, Toulouse, France.
Intensive Care Unit, Anesthesia and Critical Care department, Rangueil University Hospital, 1 Avenue Jean-Poulhes, 31059 Toulouse, France.
出版信息
J Crit Care. 2018 Apr;44:63-71. doi: 10.1016/j.jcrc.2017.10.022. Epub 2017 Oct 18.
PURPOSE
Veno-venous ECMO is increasingly used for the management of refractory ARDS. In this context, acute kidney injury (AKI) is a major and frequent complication, often associated with poor outcome. We aimed to identify characteristics associated with severe renal failure (Kidney Disease Improving Global Outcome (KDIGO) 3) and its impact on 3-month outcome.
METHODS
Between May 2009 and April 2016, 60 adult patients requiring VV-ECMO in our University Hospital were prospectively included.
RESULTS
AKI occurrence was frequent (75%; n=45), 51% of patients (n=31) developed KDIGO 3 - predominantly prior to ECMO insertion - and renal replacement therapy was required in 43% (n=26) of cases. KDIGO 3 was associated with a lower mechanical ventilation weaning rate (24% vs 68% for patients with no AKI or other stages of AKI; p<0.001) and a higher 90-day mortality rate (72% vs 32%, p=0.002). Multivariate logistic regression suggested that KDIGO 3 occurrence prior to ECMO insertion, as well as PaCO2>57mmHg and mSOFA>12 were independent risks factors for 90-day mortality.
CONCLUSION
KDIGO 3 AKI occurrence is correlated with the severity of patients' clinical condition prior to ECMO insertion and is negatively associated with 90-day survival.
目的
静脉-静脉体外膜肺氧合（VV-ECMO）越来越多地用于治疗难治性急性呼吸窘迫综合征（ARDS）。在这种情况下，急性肾损伤（AKI）是一种主要且常见的并发症，常与不良预后相关。我们旨在确定与严重肾衰竭（改善全球肾脏病预后组织（KDIGO）3 期）相关的特征及其对 3 个月结局的影响。
方法
2009 年 5 月至 2016 年 4 月期间，我们医院前瞻性纳入了 60 名需要 VV-ECMO 的成年患者。
结果
AKI 发生率较高（75%；n=45），51%的患者（n=31）发生 KDIGO 3 期-主要在 ECMO 置入前-且 43%（n=26）的患者需要肾脏替代治疗。KDIGO 3 与较低的机械通气撤机率（无 AKI 或其他 AKI 分期患者为 24%，KDIGO 3 患者为 68%；p<0.001）和更高的 90 天死亡率（无 AKI 或其他 AKI 分期患者为 32%，KDIGO 3 患者为 72%；p=0.002）相关。多变量逻辑回归提示 ECMO 置入前发生 KDIGO 3、PaCO2>57mmHg 和 mSOFA>12 是 90 天死亡率的独立危险因素。
结论
KDIGO 3 AKI 的发生与 ECMO 置入前患者临床状况的严重程度相关，与 90 天生存率呈负相关。
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