LIM 12, Disciplina de Nefrologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR.
Monte Tabor Hospital Sao Rafael, Salvador, BA, BR.
Clinics (Sao Paulo). 2021 Feb 5;76:e1924. doi: 10.6061/clinics/2021/e1924. eCollection 2021.
Positive fluid balance is frequent in critically ill patients and has been considered a potential biomarker for acute kidney injury (AKI). This study aimed to evaluate positive fluid balance as a biomarker for the early detection of AKI in critically ill patients.
This was a prospective cohort study. The sample was composed of patients ≥18 years old who stayed ≥3 days in an intensive care unit. Fluid balance, urinary output and serum creatinine were assessed daily. AKI was diagnosed by the Kidney Disease Improving Global Outcome criteria.
The final cohort was composed of 233 patients. AKI occurred in 92 patients (40%) after a median of 3 (2-6) days following ICU admission. When fluid balance was assessed as a continuous variable, a 100-ml increase in fluid balance was independently associated with a 4% increase in the odds of AKI (OR 1.04; 95% CI 1.01-1.08). Positive fluid balance categorized using different thresholds was always significantly associated with subsequent detection of AKI. The mixed effects model showed that increased fluid balance preceded AKI by 4 to 6 days.
These results suggest that a positive fluid balance might be an early biomarker for AKI development in critically ill patients.
危重症患者常出现正液体平衡，且其已被认为是急性肾损伤（AKI）的潜在生物标志物。本研究旨在评估正液体平衡作为危重症患者 AKI 早期检测的生物标志物。
这是一项前瞻性队列研究。样本由入住重症监护病房≥3 天的≥18 岁患者组成。每日评估液体平衡、尿量和血清肌酐。AKI 采用改善全球肾脏病预后组织标准诊断。
最终队列包括 233 例患者。入住 ICU 后中位 3（2-6）天内，92 例患者（40%）发生 AKI。当将液体平衡作为连续变量评估时，液体平衡增加 100ml 与 AKI 发生的几率增加 4%独立相关（OR 1.04；95%CI 1.01-1.08）。使用不同阈值对正液体平衡进行分类，均与随后 AKI 的检测显著相关。混合效应模型显示，液体平衡增加先于 AKI 发生 4-6 天。
这些结果提示，正液体平衡可能是危重症患者 AKI 发生的早期生物标志物。
