Division of Pulmonary and Critical Care Medicine, Marshall Health, Huntington, WV, United States of America.
Division of Pulmonary and Critical Care Medicine, University of West Virginia, Morgantown, WV, United States of America.
PLoS One. 2020 Feb 13;15(2):e0228274. doi: 10.1371/journal.pone.0228274. eCollection 2020.
Fluid overload is common among critically ill patients and is associated with worse outcomes. We aimed to assess the effect of diuretics on urine output, vasopressor dose, acute kidney injury (AKI) incidence, and need for renal replacement therapies (RRT) among patients who receive vasopressors.
This is a single-center retrospective study of all adult patients admitted to the intensive care unit between January 2006 and December 2016 and received >6 hours of vasopressor therapy and at least one concomitant dose of diuretic. We excluded patients from cardiac care units. Hourly urine output and vasopressor dose for 6 hours before and after the first dose of diuretic therapy was compared. Rates of AKI development and RRT initiation were assessed with a propensity-matched cohort of patients who received vasopressors but did not receive diuretics.
There was an increasing trend of prescribing diuretics in patients receiving vasopressors over the course of the study. We included 939 patients with median (IQR) age of 68(57, 78) years old and 400 (43%) female. The average hourly urine output during the first six hours following time zero in comparison with average hourly urine output during the six hours prior to time zero was significantly higher in diuretic group in comparison with patients who did not receive diuretics [81 (95% CI 73-89) ml/h vs. 42 (95% CI 39-45) ml/h, respectively; p<0.001]. After propensity matching, the rate of AKI within 7 days of exposure and the need for RRT were similar between the study and matched control patients (66 (15.6%) vs. 83 (19.6%), p = 0.11, and 34 (8.0%) vs. 37 (8.7%), p = 0.69, respectively). Mortality, however, was higher in the group that received diuretics. Ninety-day mortality was 191 (45.2%) in the exposed group VS 156 (36.9%) p = .009.
While the use of diuretic therapy in critically ill patients receiving vasopressor infusions augmented urine output, it was not associated with higher vasopressor requirements, AKI incidence, and need for renal replacement therapy.
液体超负荷在危重症患者中很常见，与预后不良有关。我们旨在评估在接受血管加压素治疗的患者中，利尿剂对尿量、血管加压素剂量、急性肾损伤（AKI）发生率和肾脏替代治疗（RRT）需求的影响。
这是一项单中心回顾性研究，纳入 2006 年 1 月至 2016 年 12 月期间入住重症监护病房并接受 >6 小时血管加压素治疗和至少一次同时使用利尿剂的所有成年患者。我们排除了心脏监护病房的患者。比较利尿剂治疗前 6 小时和后 6 小时每小时尿量和血管加压素剂量。使用接受血管加压素但未接受利尿剂治疗的患者的倾向匹配队列评估 AKI 发展和 RRT 启动率。
在研究过程中，接受血管加压素治疗的患者开具利尿剂的趋势呈上升趋势。我们纳入了 939 名中位（IQR）年龄为 68（57，78）岁的患者，其中 400 名（43%）为女性。与未接受利尿剂的患者相比，在时间零后的前 6 小时内，利尿剂组的平均每小时尿量明显高于时间零前 6 小时的平均每小时尿量[81（95%CI 73-89）ml/h 比 42（95%CI 39-45）ml/h；p<0.001]。进行倾向匹配后，暴露组和匹配对照组患者在 7 天内 AKI 的发生率和 RRT 的需求相似[66（15.6%）比 83（19.6%），p=0.11，34（8.0%）比 37（8.7%），p=0.69]。然而，接受利尿剂治疗的患者死亡率更高。暴露组 90 天死亡率为 191（45.2%），而对照组为 156（36.9%），p=0.009。
虽然在接受血管加压素输注的危重症患者中使用利尿剂治疗增加了尿量，但与更高的血管加压素需求、AKI 发生率和肾脏替代治疗需求无关。
