入重症监护病房时肌钙蛋白 I 预测脓毒症患者需要透析。

Troponin I at admission in the intensive care unit predicts the need of dialysis in septic patients.

机构信息

Postgraduation Course on Medical Sciences of the Medical School of Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.

Nephrology Division, Department of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil.

出版信息

BMC Nephrol. 2018 Nov 20;19(1):329. doi: 10.1186/s12882-018-1129-5.

DOI:10.1186/s12882-018-1129-5

PMID:30453890

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6245612/

Abstract

BACKGROUND

In a previous study we showed that troponin I (TnI) > 0.42 ng/mL predicted the need of dialysis in a group of 29 septic patients admitted to the intensive care unit (ICU). We aimed to confirm such finding in a larger independent sample.

METHODS

All septic patients admitted to an ICU from March 2016 to February 2017 were included if age between 18 and 90 years, onset of sepsis < 24 h, normal left ventricular ejection fraction, and no previous coronary or kidney diseases. TnI was measured on day 1. Patients were followed by 30 days or until death.

RESULTS

A total of 120 patients were included (51% male, 74 ± 13 years old). At ICU admission, 70 patients had TnI > 0.42 ng/mL. These patients had serum creatinine slightly higher (1.66 ± 0.34 vs. 1.32 ± 0.39 mg/dL; P < 0.0001) than those with lower TnI and similar urine output (1490 ± 682 vs. 1406 ± 631 mL; P = 0.44). At the end of the follow-up period, 70.0% of the patients with lower TnI were alive in comparison with 38.6% of those with higher TnI (p = 0.0014). After 30 days, 69.3 and 2.9% of the patients with lower and higher TnI levels remained free of dialysis, respectively (p < 0.0001). In a Cox regression model, after adjustment for gender, age, Charlson comorbidity index, serum creatinine, potassium, pH, brain natriuretic peptide and urine output, TnI > 0.42 ng/mL persisted as a strong predictor of dialysis need (hazard ratio 3.48 [95%CI 1.69-7.18]).

CONCLUSIONS

TnI levels at ICU admission are a strong independent predictor of dialysis need in sepsis.

摘要

背景

在之前的研究中，我们发现肌钙蛋白 I（TnI）>0.42ng/mL 可预测 29 例入住重症监护病房（ICU）的败血症患者需要透析。我们旨在更大的独立样本中证实这一发现。

方法

所有年龄在 18 至 90 岁之间、败血症发病时间<24 小时、左心室射血分数正常且无既往冠心病或肾病的 ICU 败血症患者均纳入研究。TnI 于入院第 1 天进行检测。患者随访 30 天或直至死亡。

结果

共纳入 120 例患者（51%为男性，74±13 岁）。入 ICU 时，70 例患者的 TnI >0.42ng/mL。这些患者的血清肌酐略高（1.66±0.34 比 1.32±0.39mg/dL；P<0.0001），但尿液输出量相似（1490±682 比 1406±631mL；P=0.44）。在随访期末，TnI 较低组的 70.0%患者存活，而 TnI 较高组的 38.6%患者存活（P=0.0014）。30 天后，TnI 较低和较高组分别有 69.3%和 2.9%的患者未接受透析（P<0.0001）。在 Cox 回归模型中，在校正性别、年龄、Charlson 合并症指数、血清肌酐、钾、pH 值、脑钠肽和尿量后，TnI >0.42ng/mL 仍然是透析需求的强预测因子（风险比 3.48[95%CI 1.69-7.18]）。