羟乙基淀粉的低累积剂量与急性缺血性脑卒中患者的急性肾损伤无关。

Lack of Association between Low Cumulative Dose of Hydroxyethyl Starch and Acute Kidney Injury in Patients with Acute Ischemic Stroke.

机构信息

Department of Neurology, Inha University Hospital, Incheon, Korea.

Department of Critical Care Medicine, Inha University Hospital, Incheon, Korea.

出版信息

J Korean Med Sci. 2020 Oct 19;35(40):e325. doi: 10.3346/jkms.2020.35.e325.

DOI:10.3346/jkms.2020.35.e325

PMID:33075852

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7572228/

Abstract

BACKGROUND

Hydroxyethyl starch (HES, 6% 130/0.4) has been used as a volume expander for the treatment of cerebral hypoperfusion in acute ischemic stroke. Although HES use was associated with renal failure in sepsis or critical illness, it still remains to be elucidated whether HES is linked to renal adverse events in patients with acute ischemic stroke.

METHODS

A total of 524 patients with acute ischemic stroke within 7 days of onset were included between January 2012 and May 2016. Renal function on admission and follow-up on day 7 ± 2 was assessed using serum creatinine (SCr) and estimated glomerular filtration rate (eGFR). Propensity score matching (PSM) was used to perform a 1:1 matched-pair analysis to minimize the group differences caused by covariates. The percentage of patients with new-onset acute renal injury (AKI) using the Kidney Disease: Improving Global Outcomes or good functional outcome (modified Rankin Scale 0-2) at 90 days were compared between HES cohort and controls.

RESULTS

Among the included patients (mean age, 68.6 years; male, 56.5%), 81 patients (15.5%) were HES cohort (median cumulative dose, 1,450 mL). Baseline renal function was better in HES cohort compared to that in the controls (SCr, 0.87 ± 0.43 mg/dL vs. 1.15 ± 1.15 mg/dL, < 0.001; eGFR, 86.91 ± 24.27 mL/min vs. 74.55 ± 29.58 mL/min, < 0.001), which became not significant in PSM cohort (72 pairs). The percentage of new-onset AKI did not differ between the HES cohort and controls (1.4% vs. 1.4%, = 1.000). In addition, new-onset AKI was not related to HES (odds ratio, 1.422; 95% confidence interval, 0.072-28.068; = 0.817) after adjusting for confounders. HES cohort tended to have higher percentage of good functional outcome at 90 days compared to controls, which failed to reach statistical significance (68.1% vs. 54.2%, = 0.087).

CONCLUSION

A low cumulative dose of HES was not associated with renal adverse events in patients with acute ischemic stroke.

摘要

背景

羟乙基淀粉（HES，6% 130/0.4）已被用作治疗急性缺血性卒中脑灌注不足的容量扩张剂。尽管 HES 的使用与脓毒症或危重病患者的肾衰竭有关，但 HES 是否与急性缺血性卒中患者的肾脏不良事件有关仍有待阐明。

方法

纳入了 2012 年 1 月至 2016 年 5 月发病后 7 天内的 524 例急性缺血性卒中患者。入院时和第 7 ± 2 天的肾功能使用血清肌酐（SCr）和估算肾小球滤过率（eGFR）评估。采用倾向评分匹配（PSM）进行 1:1 配对分析，以最小化由协变量引起的组间差异。比较 HES 组和对照组在第 90 天时使用肾脏疾病：改善全球结局或良好功能结局（改良 Rankin 量表 0-2）的新发急性肾损伤（AKI）患者的百分比。

结果

在纳入的患者中（平均年龄 68.6 岁，男性 56.5%），81 例（15.5%）为 HES 组（中位数累积剂量 1450 毫升）。与对照组相比，HES 组的基线肾功能更好（SCr，0.87 ± 0.43 mg/dL 比 1.15 ± 1.15 mg/dL，<0.001；eGFR，86.91 ± 24.27 mL/min 比 74.55 ± 29.58 mL/min，<0.001），但在 PSM 队列中差异无统计学意义（72 对）。HES 组和对照组的新发 AKI 百分比无差异（1.4%比 1.4%，= 1.000）。此外，在调整混杂因素后，HES 与新发 AKI 无关（比值比，1.422；95%置信区间，0.072-28.068；= 0.817）。与对照组相比，HES 组 90 天时良好功能结局的百分比更高，但差异无统计学意义（68.1%比 54.2%，= 0.087）。