即时检测血肌酐水平预测急性肾损伤。

Point-of-care creatinine measurements to predict acute kidney injury.

机构信息

Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Department of Intensive Care, Austin Hospital, Austin Health, Melbourne, Vic, Australia.

出版信息

Acta Anaesthesiol Scand. 2020 Jul;64(6):766-773. doi: 10.1111/aas.13564. Epub 2020 Mar 3.

DOI:10.1111/aas.13564

PMID:32057092

Abstract

BACKGROUND

Plasma creatinine (Cr) is a marker of kidney function and typically measured once daily. We hypothesized that Cr measured by point-of-care technology early after ICU admission would be a good predictor of acute kidney injury (AKI) the next day in critically ill patients.

METHODS

We conducted a retrospective database audit in a single tertiary ICU database. We included patients with normal first admission Cr (Cr ) and identified a Cr value (Cr ) obtained within 6-12 hours from ICU admission. We used their difference converted into percentage (delta-Cr-%) to predict subsequent AKI (based on Cr and/or need for renal replacement therapy) the next day. We assessed predictive value by calculating area under the receiver characteristic curve (AUC), logistic regression models for AKI with and without delta-Cr-%, and the category-free net reclassifying index (cfNRI).

RESULTS

We studied 780 patients. Overall, 70 (9.0%) fulfilled the Cr AKI definition by Cr measurement. On day 2, 148 patients (19.0%) were diagnosed with AKI. AUC (95% CI) for delta-Cr-% to predict AKI on day 2 was 0.82 (95% CI 0.78-0.86), and 0.74 (95% CI 0.69-0.80) when patients with AKI based on the Cr were excluded. Using a cut-off of 17% increment, the positive likelihood ratio (95% CI) for delta-Cr-% to predict AKI was 3.5 (2.9-4.2). The cfNRI was 90.0 (74.9-106.1).

CONCLUSIONS

Among patients admitted with normal Cr, early changes in Cr help predict AKI the following day.

摘要

背景

血浆肌酐（Cr）是肾功能的标志物，通常每日测量一次。我们假设，入住 ICU 后即刻使用即时检测技术测量的 Cr 能很好地预测次日危重症患者的急性肾损伤（AKI）。

方法

我们对单家三级 ICU 数据库进行了回顾性数据库审核。我们纳入了首次入院时 Cr 正常（Cr ）的患者，并确定了在入住 ICU 后 6-12 小时内获得的 Cr 值（Cr ）。我们使用 Cr 差值（delta-Cr-%）来预测次日（根据 Cr 和/或需要肾脏替代治疗）的 AKI。我们通过计算受试者工作特征曲线下面积（AUC）、AKI 的逻辑回归模型（包括和不包括 delta-Cr-%）以及无分类净重新分类指数（cfNRI）来评估预测价值。

结果

我们研究了 780 名患者。总体而言，有 70 名患者（9.0%）根据 Cr 测量值符合 AKI 的 Cr 定义。第 2 天，148 名患者（19.0%）被诊断为 AKI。delta-Cr-%预测第 2 天 AKI 的 AUC（95%CI）为 0.82（95%CI 0.78-0.86），排除基于 Cr 的 AKI 患者后为 0.74（95%CI 0.69-0.80）。使用 17%增量的截断值，delta-Cr-%预测 AKI 的阳性似然比（95%CI）为 3.5（2.9-4.2）。cfNRI 为 90.0（74.9-106.1）。