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对比增强超声检查获得的变量与脓毒症相关急性肾损伤的相关性的前瞻性观察性研究方案。

Protocol for a prospective observational study on the association of variables obtained by contrast-enhanced ultrasonography and sepsis-associated acute kidney injury.

机构信息

Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.

Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China

出版信息

BMJ Open. 2019 Jul 29;9(7):e023981. doi: 10.1136/bmjopen-2018-023981.

DOI:10.1136/bmjopen-2018-023981
PMID:31362958
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6677954/
Abstract

INTRODUCTION

Sepsis commonly results in acute kidney injury (AKI), whereas about 50% of AKI cases are due to sepsis. Sepsis-associated acute kidney injury (SA-AKI) increases morbidity and mortality especially among critically ill patients. This study aims to monitor renal microcirculation perfusion during sepsis using contrast-enhanced ultrasonography (CEUS), and to explore whether CEUS is useful for predicting the development of SA-AKI.

METHODS AND ANALYSIS

This prospective observational study will enrol patients who were diagnosed with sepsis-3 definition. The total of septic or septic shock patients were stratified into AKI (including stages 1, 2 and 3) and non-AKI groups according to Kidney Disease Improving Global Outcomes criteria on days 0, 1, 2 and 7 after admission to the emergency intensive care unit, meanwhile, the CEUS technique will be performed to monitor renal microcirculation perfusion. A multivariable model including all CEUS variables were expected to create for predicting the development of AKI during sepsis. Ultrasonography results, demographic information, therapeutic interventions, survival outcomes, laboratory and other clinical datas will also be collected for further analysis.

ETHICS AND DISSEMINATION

The study protocol was approved on 2 August 2017 by the Ethics Committee of Sir Run Run Shaw Hospital (Zhejiang University Medical College) (approval number: 2016C91401). The results will be published in a peer-reviewed journal and shared with the worldwide medical community within 2 years after the start of the recruitment.

TRIAL REGISTRATION NUMBER

ISRCTN14728986.

摘要

简介

败血症常导致急性肾损伤(AKI),而约 50%的 AKI 病例是由败血症引起的。与败血症相关的急性肾损伤(SA-AKI)会增加发病率和死亡率,尤其是在重症患者中。本研究旨在使用对比增强超声(CEUS)监测败血症期间的肾脏微循环灌注,并探讨 CEUS 是否有助于预测 SA-AKI 的发生。

方法和分析

本前瞻性观察性研究将纳入符合败血症-3 定义的患者。根据入院后第 0、1、2 和 7 天的肾脏疾病改善全球结局(KDIGO)标准,将所有败血症或败血症性休克患者分为 AKI(包括 1、2 和 3 期)和非 AKI 组,同时进行 CEUS 技术监测肾脏微循环灌注。预计将创建一个包含所有 CEUS 变量的多变量模型,以预测败血症期间 AKI 的发生。还将收集超声检查结果、人口统计学信息、治疗干预措施、生存结局、实验室和其他临床数据,以进行进一步分析。

伦理和传播

该研究方案于 2017 年 8 月 2 日获得浙江大学医学院附属邵逸夫医院伦理委员会的批准(批准号:2016C91401)。研究结果将在招募开始后 2 年内发表在同行评议的期刊上,并与全球医学界分享。

试验注册号

ISRCTN82306006。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0784/6677954/c6887e197ca7/bmjopen-2018-023981f02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0784/6677954/0b8b11deb669/bmjopen-2018-023981f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0784/6677954/c6887e197ca7/bmjopen-2018-023981f02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0784/6677954/0b8b11deb669/bmjopen-2018-023981f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0784/6677954/c6887e197ca7/bmjopen-2018-023981f02.jpg

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本文引用的文献

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Crit Care Med. 2018 Aug;46(8):1284-1292. doi: 10.1097/CCM.0000000000003209.
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Recent advances in the pathogenetic mechanisms of sepsis-associated acute kidney injury.脓毒症相关性急性肾损伤发病机制的最新进展。
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Development of scoring system for risk stratification in clinical medicine: a step-by-step tutorial.
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Evaluation of Contrast-Enhanced Ultrasound in Diagnosis of Acute Kidney Injury of Patients in Intensive Care Unit.超声造影在重症监护病房患者急性肾损伤诊断中的应用评估
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Transcription factor nuclear factor erythroid 2 p45-related factor 2 (NRF2) ameliorates sepsis-associated acute kidney injury by maintaining mitochondrial homeostasis and improving the mitochondrial function.转录因子红细胞衍生 2 相关因子 2(NRF2)通过维持线粒体动态平衡和改善线粒体功能来减轻脓毒症相关急性肾损伤。
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