Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2019 Aug;94(8):1509-1515. doi: 10.1016/j.mayocp.2019.01.040. Epub 2019 Jul 3.
To assess whether loop diuretic challenge predicts the need for dialysis among critically ill patients with acute kidney injury (AKI) stage 3.
Adult patients admitted to intensive care units between January 1, 2004, and December 31, 2016, were screened. Acute kidney injury stage 3 was identified by an electronic surveillance tool, and patients who received loop diuretics in a dosage of at least 1mg/kg intravenous bolus furosemide equivalent were included. Urine output following loop diuretic challenge was modeled as a restricted cubic spline. We then compared the area under the receiver operating characteristic curve for urine outputs at 2 hours and 6 hours after loop diuretic challenge to predict the need for dialysis within the next 24 hours.
Of 687 patients included in the study, those who received dialysis were younger and had higher Sequential Organ Failure Assessment scores on the day of loop diuretic challenge. Urine outputs at 2 hours and 6 hours were lower in patients who needed dialysis, but urine output by 6 hours was better in predicting dialysis initiation within 24 hours (area under the curve, 0.71 vs 0.67; P=.02). The sensitivity and specificity of 6-hour urine output cutoff of 600 mL or less to predict dialysis was 80.9% and 50.5%, respectively, and that for 300 mL or less was 64.2% and 68.2%, respectively.
Among patients with stage 3 AKI, 6-hour urine output after the loop diuretic challenge had a modest discriminant capacity to identify dialysis initiation within the next 24 hours.
评估在急性肾损伤（AKI）3 期的危重症患者中，袢利尿剂挑战是否可预测透析的需求。
2004 年 1 月 1 日至 2016 年 12 月 31 日期间筛选入住重症监护病房的成年患者。通过电子监测工具识别 AKI 3 期，纳入至少接受 1mg/kg 静脉推注呋塞米等效剂量的袢利尿剂的患者。在袢利尿剂挑战后，将尿量建模为限制立方样条。然后，我们比较了 2 小时和 6 小时后袢利尿剂挑战后尿量的受试者工作特征曲线下面积，以预测在接下来的 24 小时内需要透析。
在纳入的 687 例患者中，接受透析的患者年龄更小，在接受袢利尿剂挑战的当天，序贯器官衰竭评估评分更高。需要透析的患者在 2 小时和 6 小时的尿量较低，但 6 小时的尿量更能预测 24 小时内开始透析（曲线下面积，0.71 对 0.67；P=.02）。6 小时尿量<600 mL 或<300 mL 的截断值预测透析的敏感性和特异性分别为 80.9%和 50.5%、64.2%和 68.2%。
在 AKI 3 期患者中，袢利尿剂挑战后 6 小时的尿量对识别接下来 24 小时内开始透析具有适度的判别能力。
