重症急性肾损伤合并液体超负荷患者持续肾脏替代治疗的时机：一项回顾性队列研究。
Timing of continuous renal replacement therapy in severe acute kidney injury patients with fluid overload: A retrospective cohort study.
作者信息
Lin J, Ji X J, Wang A Y, Liu J F, Liu P, Zhang M, Qi Z L, Guo D C, Bellomo R, Bagshaw S M, Wald R, Gallagher M, Duan M L
机构信息
Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, China.
The George Institute for Global Health, Newtown, Australia; Concord Clinical School, The University of Sydney, Australia; Department of Renal Medicine, Concord Repatriation General Hospital, Australia.
出版信息
J Crit Care. 2021 Aug;64:226-236. doi: 10.1016/j.jcrc.2021.04.017. Epub 2021 May 3.
PURPOSE
We aimed to evaluate the association of early versus late initiation of Continuous renal replacement therapy (CRRT) with mortality in patients with fluid overload.
METHODS
This was a retrospective cohort study of patients with fluid overload (FO) treated with CRRT due to severe acute kidney injury (AKI) between January 2015 and December 2017 in a mixed medical intensive care unit of a teaching hospital in Beijing, China. Patients were divided into early (≤15 h) and late (>15 h) groups based on the median time from ICU admission to CRRT initiation. The primary outcome was all-cause mortality at day 60. Multivariable Cox model analysis was used for analysis.
RESULTS
The study patients were male predominant (84/150) with a mean age of 64.8 ± 16.7 years. The median FO value before CRRT initiation was 10.1% [6.2-16.1%]. The 60-day mortality rates in the early vs the late CRRT groups were 53.9% and 73%, respectively. On multivariable Cox modelling, the late initiation of CRRT was independently associated with an increased risk of death at 60 days (HR 1.75, 95% CI 1.11-2.74, p = 0.015).
CONCLUSIONS
Early initiation of CRRT was independently associated with survival benefits in severe AKI patients with fluid overload.
目的
我们旨在评估连续性肾脏替代治疗（CRRT）早期与晚期开始治疗对液体超负荷患者死亡率的影响。
方法
这是一项回顾性队列研究，研究对象为2015年1月至2017年12月在中国北京一家教学医院的混合医疗重症监护病房因严重急性肾损伤（AKI）接受CRRT治疗的液体超负荷（FO）患者。根据从入住重症监护病房（ICU）到开始CRRT的中位时间，将患者分为早期（≤15小时）和晚期（>15小时）组。主要结局是第60天的全因死亡率。采用多变量Cox模型分析。
结果
研究患者以男性为主（84/150），平均年龄为64.8±16.7岁。CRRT开始前的中位FO值为10.1%[6.2-16.1%]。早期与晚期CRRT组的60天死亡率分别为53.9%和73%。在多变量Cox模型中，CRRT延迟开始与60天时死亡风险增加独立相关（风险比1.75，95%置信区间1.11-2.74，p=0.015）。
结论
对于伴有液体超负荷的严重AKI患者，早期开始CRRT与生存获益独立相关。
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