Park Yoo Seok, Choi Yoon Hee, Oh Je Hyeok, Cho In Soo, Cha Kyoung-Chul, Choi Byung-Sun, You Je Sung
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Emergency Medicine, Ewha Womans University Medical Center and Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.
Crit Care. 2019 Jul 15;23(1):256. doi: 10.1186/s13054-019-2535-1.
Acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) is a well-known predictor for mortality. However, the natural course of AKI including recovery rate after OHCA is uncertain. This study investigated the clinical course of AKI after OHCA and determined whether recovery from AKI impacted the outcomes of OHCA.
This retrospective multicentre cohort study included adult OHCA patients treated with targeted temperature management (TTM) between January 2016 and December 2017. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes criteria. The primary outcome was the recovery rate after AKI and its association with survival and good neurological outcome at discharge.
A total of 3697 OHCA patients from six hospitals were screened and 275 were finally included. AKI developed in 175/275 (64%) patients and 69/175 (39%) patients recovered from AKI. In most cases, AKI developed within three days of return of spontaneous circulation [155/175 (89%), median time to AKI development 1 (1-2) day] and patients recovered within seven days of return of spontaneous circulation [59/69 (86%), median time to AKI recovery 3 (2-7) days]. Duration of AKI was significantly longer in the AKI non-recovery group than in the AKI recovery group [5 (2-9) vs. 1 (1-5) days; P < 0.001]. Most patients were diagnosed with AKI stage 1 initially [120/175 (69%)]. However, the number of stage 3 AKI patients increased from 30/175 (17%) to 77/175 (44%) after the initial diagnosis of AKI. The rate of survival discharge was significantly higher in the AKI recovery group than in the AKI non-recovery group [45/69 (65%) vs. 17/106 (16%); P < 0.001]. Recovery from AKI was a potent predictor of survival and good neurological outcome at discharge in the multivariate analysis (adjusted odds ratio, 8.308; 95% confidence interval, 3.120-22.123; P < 0.001 and adjusted odds ratio, 36.822; 95% confidence interval, 4.097-330.926; P = 0.001).
In our cohort of adult OHCA patients treated with TTM (n = 275), the recovery rate from AKI after OHCA was 39%, and recovery from AKI was a potent predictor of survival and good neurological outcome at discharge.
院外心脏骤停（OHCA）后发生的急性肾损伤（AKI）是死亡率的一个众所周知的预测指标。然而，AKI的自然病程，包括OHCA后的恢复率尚不确定。本研究调查了OHCA后AKI的临床病程，并确定AKI的恢复是否会影响OHCA的结局。
这项回顾性多中心队列研究纳入了2016年1月至2017年12月期间接受目标温度管理（TTM）治疗的成年OHCA患者。使用改善全球肾脏病预后组织（KDIGO）标准诊断AKI。主要结局是AKI后的恢复率及其与出院时生存和良好神经功能结局的关联。
共筛查了来自六家医院的3697例OHCA患者，最终纳入275例。175/275（64%）例患者发生了AKI，其中69/175（39%）例患者从AKI中恢复。在大多数情况下，AKI在自主循环恢复后的三天内发生[155/175（89%），AKI发生的中位时间为1（1-2）天]，患者在自主循环恢复后的七天内恢复[59/69（86%），AKI恢复的中位时间为3（2-7）天]。AKI未恢复组的AKI持续时间显著长于AKI恢复组[5（2-9）天对1（1-5）天；P<0.001]。大多数患者最初被诊断为1期AKI[120/175（69%）]。然而，在AKI初步诊断后，3期AKI患者的数量从30/175（17%）增加到77/175（44%）。AKI恢复组的出院生存率显著高于AKI未恢复组[45/69（65%）对17/106（16%）；P<0.001]。在多变量分析中，AKI的恢复是出院时生存和良好神经功能结局的有力预测指标（调整后的优势比，8.308；95%置信区间，3.120-22.123；P<0.001，调整后的优势比，36.822；95%置信区间，4.097-330.926；P=0.001）。
在我们接受TTM治疗的成年OHCA患者队列（n=275）中，OHCA后AKI的恢复率为39%，AKI的恢复是出院时生存和良好神经功能结局的有力预测指标。
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