Emergency Department, Cangzhou Central Hospital, Yunhe Qu, Cangzhou, China.
Ultrasonic Department, Cangzhou Central Hospital, Yunhe Qu, Cangzhou, China.
J Intensive Care Med. 2021 Jan;36(1):115-122. doi: 10.1177/0885066619887333. Epub 2019 Nov 13.
Diagnosing acute kidney injury (AKI) stage 3 in critically ill patients may help physicians in making treatment decisions. This diagnosis relies chiefly on urinary output and serum creatinine, which may be of limited value. This study aimed to explore the diagnostic performance of renal resistive index (RRI) and semiquantitative power Doppler ultrasound (PDU) scores in predicting AKI stage 3 in patients with sepsis or cardiac failure.
This study is a prospective observational study that included 83 patients (40 with sepsis and 43 with cardiac failure). Renal resistive index and semiquantitative PDU scores were measured within 6 hours following admission to the intensive care unit. Acute kidney injury was defined according to the criteria set by Kidney Disease Improving Global Outcomes.
The predictive values of RRI (area under the curve [AUC] = 0.772, 95% confidence interval [CI] = 0.658-0.886) and PDU score (AUC = 0.780, 95% CI = 0.667-0.892) were similar in all patients. Power Doppler ultrasound score (AUC = 0.910, 95% CI = 0.815-1.000) could effectively predict AKI stage 3 in the cardiac failure subgroup, and the optimal cutoff for this parameter was ≤ 1 (sensitivity = 87.5%, specificity = 92.6%, Youden index = 0.801, accuracy in our population = 90.7%). However, PDU scores (AUC = 0.620, 95% CI = 0.425-0.814) could not predict AKI stage 3 in the sepsis subgroup. The predictive values of RRI for AKI stage 3 in the cardiac failure (AUC = 0.820, 95% CI = 0.666-0.974) and sepsis (AUC = 0.724, 95% CI = 0.538-0.910) subgroups were similar.
Power Doppler ultrasound scores could effectively predict AKI stage 3 in patients with cardiac failure but not in patients with sepsis. Renal resistive index is a poor predictor of AKI stage 3 in patients with sepsis or cardiac failure.
在危重病患者中诊断急性肾损伤（AKI）3 期有助于医生做出治疗决策。该诊断主要依赖于尿输出量和血清肌酐，但其可能具有一定的局限性。本研究旨在探讨肾阻力指数（RRI）和半定量能量多普勒超声（PDU）评分在预测脓毒症或心力衰竭患者 AKI 3 期中的诊断性能。
这是一项前瞻性观察研究，纳入了 83 名患者（40 名脓毒症患者和 43 名心力衰竭患者）。在入住重症监护病房后 6 小时内测量肾阻力指数和半定量 PDU 评分。急性肾损伤根据肾脏病改善全球结局（KDIGO）标准定义。
在所有患者中，RRI（曲线下面积 [AUC] = 0.772，95%置信区间 [CI] = 0.658-0.886）和 PDU 评分（AUC = 0.780，95%CI = 0.667-0.892）的预测值相似。PDU 评分（AUC = 0.910，95%CI = 0.815-1.000）可有效预测心力衰竭亚组的 AKI 3 期，该参数的最佳截断值为≤1（灵敏度为 87.5%，特异性为 92.6%，约登指数为 0.801，人群准确性为 90.7%）。然而，PDU 评分（AUC = 0.620，95%CI = 0.425-0.814）不能预测脓毒症亚组的 AKI 3 期。心力衰竭（AUC = 0.820，95%CI = 0.666-0.974）和脓毒症（AUC = 0.724，95%CI = 0.538-0.910）亚组中 RRI 对 AKI 3 期的预测值相似。
PDU 评分可有效预测心力衰竭患者的 AKI 3 期，但不能预测脓毒症患者的 AKI 3 期。RRI 是脓毒症或心力衰竭患者 AKI 3 期的较差预测指标。
