基于体重的急性肾损伤患者液体超负荷评估。

Weight-Based Assessment of Fluid Overload in Patients with Acute Kidney Injury.

机构信息

Department of Renal Medicine, Changi General Hospital, Singapore, Singapore.

Anaesthetics and Critical Care, Borders General Hospital, Melrose, United Kingdom.

出版信息

Nephron. 2020;144(6):281-289. doi: 10.1159/000506398. Epub 2020 May 13.

DOI:10.1159/000506398

PMID:32403114

Abstract

INTRODUCTION

Acute kidney injury (AKI) with fluid overload is associated with poor outcomes. While percentage fluid overload (PFO) using intake/output charts (PFOi/o) has been validated as a marker of overload, accurate PFOi/o measurements may not be possible in a general ward. We propose an alternative weight-based PFO calculation: PFOw = [(maximum weight - baseline weight) ÷ baseline weight] × 100%.

METHODS

This is a prospective, observational pilot study on general ward inpatients with AKI who were referred for nephrology consult. PFOw was compared with PFOi/o, and both were evaluated for associations with dialysis requirement, AKI stage 2 or 3, and 90-day mortality.

RESULTS

Fifty-eight patients with a median age of 67.5 years (interquartile range 18.0) were recruited. Of which, 33 (56.9%) were males and 41 (70.7%) had preexisting CKD 3 or higher. We found no correlation between PFOi/o and PFOw (R2 = 0.015, p = 0.531). A higher PFOw was observed in AKI stage 2 or 3 (p = 0.005) and in patients requiring dialysis (p = 0.001). On multivariate analysis, each percentage increase in PFOw was associated with increased odds of AKI stage 2 or 3 (odds ratio 1.37 [95% CI 1.05-1.78], p = 0.020) and dialysis need (odds ratio 1.69 [95% CI 1.20-2.39], p = 0.003). Twenty-nine patients had complete quantitative data to calculate PFOi/o. Multivariate analysis of these 29 patients showed that PFOw correlated with AKI stage 2 or 3 and dialysis requirement, while PFOi/o had no correlation with these events. The area under the curve receiver operating characteristics of PFOw was 0.706 for AKI stage 2 or 3 and 0.819 for AKI requiring dialysis. The optimal PFOw cutoff was determined at ≥1%. Three deaths occurred within 90 days, and all had PFOw ≥ 1%, although the log-rank test did not achieve statistical significance (p = 0.050).

CONCLUSION

The proposed PFOw is a potential prognostic indicator for general ward patients with AKI. PFOw ≥ 1% is associated with poor renal outcomes.

摘要

介绍

伴有液体超负荷的急性肾损伤（AKI）与不良预后相关。虽然使用摄入量/输出量图表（PFOi/o）计算的液体超负荷百分比（PFO）已被验证为超负荷的标志物，但在普通病房中可能无法进行准确的 PFOi/o 测量。我们提出了一种替代的基于体重的 PFO 计算方法：PFOw = [(最大体重 - 基线体重) ÷ 基线体重] × 100%。

方法

这是一项在普通病房 AKI 患者中进行的前瞻性、观察性试点研究，这些患者被转介接受肾脏病学咨询。比较了 PFOw 与 PFOi/o，并评估了两者与透析需求、AKI 2 或 3 期和 90 天死亡率的相关性。

结果

共纳入 58 例中位年龄为 67.5 岁（四分位距 18.0）的患者。其中，33 例（56.9%）为男性，41 例（70.7%）患有预先存在的 CKD 3 期或更高分期。我们发现 PFOi/o 与 PFOw 之间没有相关性（R2 = 0.015，p = 0.531）。在 AKI 2 或 3 期（p = 0.005）和需要透析的患者中，PFOw 较高（p = 0.001）。多变量分析显示，PFOw 每增加一个百分点，AKI 2 或 3 期的发生几率就会增加 1.37 倍（95%CI 1.05-1.78，p = 0.020），需要透析的几率也会增加 1.69 倍（95%CI 1.20-2.39，p = 0.003）。29 例患者有完整的定量数据可用于计算 PFOi/o。对这 29 例患者的多变量分析显示，PFOw 与 AKI 2 或 3 期和透析需求相关，而 PFOi/o 与这些事件无关。PFOw 的 AKI 2 或 3 期和需要透析的曲线下面积接收者操作特征曲线的 AUC 分别为 0.706 和 0.819。确定 PFOw 的最佳截断值为≥1%。90 天内有 3 例死亡，均有 PFOw ≥ 1%，尽管对数秩检验未达到统计学意义（p = 0.050）。