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急性肾损伤幸存者持续肾脏替代治疗时间的预测因素。

Predictive Factors of Duration of Continuous Renal Replacement Therapy in Acute Kidney Injury Survivors.

机构信息

Division of Nephrology, Department of Internal Medicine, Mediplex Sejong Hospital, Incheon, South Korea.

Division of Nephrology, Department of Internal Medicine, Sejong General Hospital, Bucheon, South Korea.

出版信息

Shock. 2019 Dec;52(6):598-603. doi: 10.1097/SHK.0000000000001328.

Abstract

The factors influencing continuous renal replacement therapy (CRRT) duration for critically ill patients with acute kidney injury (AKI) are unclear. Therefore, we investigated the clinical factors that could influence the duration of CRRT for AKI survivors. In this retrospective observational study, the medical records of all hospital survivors who required CRRT for AKI in intensive care units were analyzed. The CRRT duration (median, 6 days) was categorized as short-duration CRRT (≤ 6 days, n = 65) and long-duration CRRT (> 6 days, n = 59), according to the median CRRT duration. A urine output of less than 0.5 mL/kg/h (adjusted odds ratio [OR], 3.4; P = 0.010), mechanical ventilation use (adjusted OR, 7.9; P = 0.001), and extracorporeal membrane oxygenation (ECMO) use (adjusted OR, 6.5; P = 0.010) were independent predictors of long-duration CRRT, whereas serum creatinine and neutrophil gelatinase-associated lipocalin were not significant predictors. A clinical model demonstrated a good discriminatory ability to predict long-duration CRRT (area under the curve, 0.84; 95% confidence interval, 0.76-0.90). The urine output immediately before CRRT initiation and factors associated with disease severity significantly affected the duration of CRRT. Simultaneously considering the urine output, mechanical ventilation use, and ECMO use predicted CRRT duration in AKI survivors.

摘要

影响急性肾损伤(AKI)危重症患者连续性肾脏替代治疗(CRRT)时间的因素尚不清楚。因此,我们研究了可能影响 AKI 幸存者 CRRT 时间的临床因素。在这项回顾性观察研究中,分析了所有在重症监护病房因 AKI 需要接受 CRRT 的医院幸存者的病历。根据 CRRT 时间中位数,将 CRRT 时间(中位数 6 天)分为短时间 CRRT(≤6 天,n=65)和长时间 CRRT(>6 天,n=59)。根据多因素回归分析,尿量<0.5mL/kg/h(调整优势比[OR],3.4;P=0.010)、机械通气(调整 OR,7.9;P=0.001)和体外膜氧合(ECMO)(调整 OR,6.5;P=0.010)是长时间 CRRT 的独立预测因素,而血清肌酐和中性粒细胞明胶酶相关脂质运载蛋白不是显著预测因素。临床模型对预测长时间 CRRT 具有良好的区分能力(曲线下面积,0.84;95%置信区间,0.76-0.90)。CRRT 开始前的即时尿量和与疾病严重程度相关的因素显著影响 CRRT 的持续时间。同时考虑尿量、机械通气和 ECMO 的使用可预测 AKI 幸存者的 CRRT 时间。

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