甲型 H1N1pdm09 流感病毒导致的严重急性呼吸窘迫综合征患者急性肾损伤的转归。

Outcomes of Acute Kidney Injury in Patients With Severe ARDS Due to Influenza A(H1N1) pdm09 Virus.

机构信息

Christopher J. Tignanelli is a surgical critical care fellow, University of Michigan Health System, Ann Arbor, Michigan. Arek J. Wiktor is an assistant professor of surgery, University of Colorado, Denver, Colorado. Cory J. Vatsaas is an assistant professor of surgery, Duke University Health System, Durham, North Carolina. Gaurav Sachdev is an assistant professor of surgery, Carolinas Medical Center, Charlotte, North Carolina. Michael Heung is an associate professor of medicine, Division of Nephrology, University of Michigan Health System. Pauline K. Park and Krishnan Raghavendran are professors of surgery, University of Michigan Health System. Lena M. Napolitano is professor of surgery, division chief of acute care surgery, director of trauma and surgical critical care, and associate chair of the Department of Surgery, University of Michigan Health System.

出版信息

Am J Crit Care. 2018 Jan;27(1):67-73. doi: 10.4037/ajcc2018901.

DOI:10.4037/ajcc2018901

PMID:29292278

Abstract

BACKGROUND

The incidence and long-term outcomes of acute kidney injury in patients with severe acute respiratory distress syndrome (ARDS) due to influenza A(H1N1) pdm09 virus (pH1N1) have not been examined.

OBJECTIVE

To assess long-term renal recovery in patients with acute kidney injury and severe ARDS due to pH1N1.

METHODS

A retrospective observational cohort study of adults with severe pH1N1-associated ARDS admitted to a tertiary referral center. Baseline characteristics, acute kidney injury stage, continuous renal replacement therapy (CRRT), intermittent hemodialysis, extracorporeal membrane oxygenation, survival, and renal recovery (defined as dialysis independence) were evaluated.

RESULTS

Fifty-seven patients, most with stage 3 acute kidney injury, were included. The 53% mortality rate among the 38 patients requiring CRRT was significantly higher than the 0% mortality rate among the 19 patients not requiring CRRT or intermittent hemodialysis. Increased duration of CRRT was not significantly associated with decreased survival. Fifteen CRRT patients required transition to intermittent hemodialysis. Of the CRRT patients who survived, 94% experienced renal recovery. Extracorporeal membrane oxygenation was instituted in 17 patients; 15 of these patients required CRRT.

CONCLUSIONS

Acute kidney injury is common in patients with severe ARDS caused by pH1N1 infection. CRRT is a significant risk factor for increased mortality, but most patients who survived experienced full renal recovery.

摘要

背景

甲型 H1N1 流感病毒（pH1N1）引起的严重急性呼吸窘迫综合征（ARDS）患者发生急性肾损伤的发病率和长期结局尚未得到研究。

目的

评估 pH1N1 引起的急性肾损伤和严重 ARDS 患者的长期肾脏恢复情况。

方法

对一家三级转诊中心收治的成人严重 pH1N1 相关 ARDS 患者进行回顾性观察队列研究。评估基线特征、急性肾损伤分期、连续性肾脏替代治疗（CRRT）、间歇性血液透析、体外膜氧合、生存和肾脏恢复（定义为透析依赖）。

结果

共纳入 57 例患者，大多数患者处于急性肾损伤 3 期。需要 CRRT 的 38 例患者中有 53%的死亡率明显高于不需要 CRRT 或间歇性血液透析的 19 例患者的 0%死亡率。CRRT 时间延长与生存率降低无关。15 例 CRRT 患者需要转为间歇性血液透析。在存活的 CRRT 患者中，94%的患者实现了肾脏恢复。17 例患者接受了体外膜氧合治疗；其中 15 例患者需要 CRRT。