Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Sci Rep. 2019 Aug 19;9(1):11981. doi: 10.1038/s41598-019-48418-4.
Acute kidney injury (AKI) in patients with septic shock is associated with high mortality, but the appropriate timing for initiating continuous renal replacement therapy (CRRT) is controversial. We retrospectively enrolled 158 septic shock patients with AKI in the medical intensive care unit (ICU) from July 2016 to April 2018. The time from AKI onset to CRRT initiation was compared according to ICU mortality using Cox proportional hazard, receiver operating characteristic, and Kaplan-Meier survival analyses. At the time of ICU discharge, the mortality rate was 50.6% (n = 80). It took longer to initiate CRRT in non-survivors than in survivors (hazard ratio 1.009; 95% confidence interval [CI] 1.003-1.014; P = 0.002). The cut-off time from AKI onset to CRRT initiation for ICU mortality was 16.5 hours (area under the curve 0.786; 95% CI 0.716-0.856; P < 0.001). The cumulative mortality rate was significantly higher in patients in whom CRRT was initiated beyond 16.5 hours after AKI onset than in those in whom CCRT was initiated within 16.5 hours (log-rank test, P < 0.001). Several clinical situations must be considered to determine the optimal timing of CRRT initiation in these patients. Close observation and CRRT initiation within 16.5 hours after AKI onset may help improve survival.
在合并感染性休克的急性肾损伤（AKI）患者中，急性肾损伤与高死亡率相关，但开始持续肾脏替代治疗（CRRT）的适当时机仍存在争议。我们回顾性纳入了 2016 年 7 月至 2018 年 4 月在重症监护病房（ICU）发生 AKI 的 158 例感染性休克患者。使用 Cox 比例风险、受试者工作特征和 Kaplan-Meier 生存分析，根据 ICU 死亡率比较 AKI 发作至 CRRT 开始的时间。在 ICU 出院时，死亡率为 50.6%（n=80）。与幸存者相比，非幸存者开始 CRRT 的时间更长（风险比 1.009；95%置信区间 [CI] 1.003-1.014；P=0.002）。AKI 发作至 CRRT 开始的 ICU 死亡率截断时间为 16.5 小时（曲线下面积 0.786；95%CI 0.716-0.856；P<0.001）。AKI 发作后 16.5 小时开始 CRRT 的患者累积死亡率明显高于 AKI 发作后 16.5 小时内开始 CRRT 的患者（对数秩检验，P<0.001）。必须考虑几种临床情况来确定这些患者开始 CRRT 的最佳时机。密切观察并在 AKI 发作后 16.5 小时内开始 CRRT 可能有助于提高生存率。
