Engoren Milo, Maile Michael D, Heung Michael, Blum James M, Blank Ross, Napolitano Lena M, Park Pauline K, Raghavendran Krishnan, Jewell Elizabeth S, Meldrum Craig
Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
J Intensive Care Soc. 2021 Feb;22(1):8-16. doi: 10.1177/1751143719892792. Epub 2019 Dec 5.
To determine if earlier initiation of renal replacement therapy (RRT) is associated with improved survival in patients with severe acute kidney injury.
We performed a retrospective case-control study of propensity-matched groups with multivariable logistic regression using Akaike Information Criteria to adjust for non-matched variables in a surgical ICU in a tertiary care hospital.
We matched 169 of 205 (82%) patients with new initiation of RRT (EARLY group) to 169 similar patients who did not initiate RRT on that day (DEFERRED group). Eighteen (11%) of DEFERRED eventually received RRT before discharge. By univariate analysis, ICU mortality was higher in EARLY (n = 60 (36%) vs. n = 23 (14%), < 0.001) as was hospital mortality (n = 73 (43%) vs. n = 44 (26%), = 0.001). Of the 18 RRT patients in DEFERRED, 12 (67%) died in ICU and 13 (72%) in hospital. After propensity matching and logistic regression, we found that EARLY initiation of RRT was associated with a more than doubling of ICU mortality (aOR = 2.310, 95% confidence interval = 1.254-4.257, = 0.007). However, after similar adjustment, there was no difference in hospital mortality (aOR = 1.283, 95% CI = 0.753-2.186, = 0.360).
While ICU mortality was increased in the EARLY group, there was no difference in hospital mortality between EARLY and DEFERRED groups.
确定早期开始肾脏替代治疗（RRT）是否与重症急性肾损伤患者生存率的提高相关。
我们在一家三级护理医院的外科重症监护病房进行了一项回顾性病例对照研究，对倾向匹配组进行多变量逻辑回归分析，并使用赤池信息准则对未匹配变量进行调整。
我们将205例新开始接受RRT的患者中的169例（82%）（早期组）与169例当天未开始接受RRT的类似患者（延迟组）进行匹配。延迟组中有18例（11%）最终在出院前接受了RRT。单因素分析显示，早期组的重症监护病房死亡率更高（n = 60（36%）对n = 23（14%），P < 0.001），医院死亡率也是如此（n = 73（43%）对n = 44（26%），P = 0.001）。延迟组的18例接受RRT的患者中，12例（67%）在重症监护病房死亡，13例（72%）在医院死亡。经过倾向匹配和逻辑回归分析，我们发现早期开始RRT与重症监护病房死亡率增加一倍以上相关（调整后比值比[aOR] = 2.310，95%置信区间[CI] = 1.254 - 4.257，P = 0.007）。然而，经过类似调整后，医院死亡率没有差异（aOR = 1.283，95% CI = 0.753 - 2.186，P = 0.360）。
虽然早期组的重症监护病房死亡率有所增加，但早期组和延迟组之间的医院死亡率没有差异。
