Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada.
Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada.
J Crit Care. 2019 Aug;52:109-114. doi: 10.1016/j.jcrc.2019.04.011. Epub 2019 Apr 9.
To validate the furosemide stress test (FST) for predicting the progression of acute kidney injury (AKI).
We performed a multicenter, prospective, observational study in patients with stage I or II AKI. The FST (1 mg/kg for loop diuretic naïve patients and 1.5 mg/kg in patients previously exposed to loop diuretics) was administered. Subsequent urinary flow rate (UFR) recorded and predictive ability of urinary output was measured by the area under the curve receiver operatic characteristics (AuROC). Primary outcome was progression to Stage III AKI. Secondary outcomes included in-hospital mortality and adverse events.
We studied 92 critically ill patients. 23 patients progressed to stage III AKI and had significantly lower UFR (p < 0.0001). The UFR during the first 2 h was most predictive of progression to stage III AKI (AuROC = 0.87), with an ideal cut-off of less than 200mls, with a sensitivity of 73.9% and specificity of 90.0%.
In ICU patients without severe CKD with mild AKI, a UFR of less than 200mls in the first 2 h after an FST is predictive of progression to stage III AKI. Future studies should focus on incorporating a FST as part of a clinical decision tool for further management of critically ill patients with AKI.
验证呋塞米应激试验（FST）预测急性肾损伤（AKI）进展的能力。
我们进行了一项多中心、前瞻性、观察性研究，纳入了 I 期或 II 期 AKI 患者。给予 FST（对于未使用过袢利尿剂的患者给予 1mg/kg，对于之前使用过袢利尿剂的患者给予 1.5mg/kg）。随后记录尿流率（UFR），并通过曲线下面积接收者操作特征（AuROC）来测量尿量的预测能力。主要结局为进展为 III 期 AKI。次要结局包括住院死亡率和不良事件。
我们研究了 92 名重症患者。23 名患者进展为 III 期 AKI，UFR 显著降低（p<0.0001）。前 2 小时的 UFR 对进展为 III 期 AKI 的预测能力最强（AuROC=0.87），理想截点为小于 200ml/s，敏感性为 73.9%，特异性为 90.0%。
在无严重 CKD 的轻度 AKI 重症患者中，FST 后前 2 小时 UFR 小于 200ml/s 提示进展为 III 期 AKI。未来的研究应侧重于将 FST 纳入重症 AKI 患者的临床决策工具，以进一步管理这些患者。
