Department of Critical Care Medicine, General Hospital of Southern Theatre Command of Peoples Liberation Army, Guangzhou, China.
The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Ren Fail. 2021 Dec;43(1):1561-1568. doi: 10.1080/0886022X.2021.2008975.
Patients with rhabdomyolysis (RM) following exertional heatstroke (EHS) are often accompanied by dysfunction of coagulation and acute kidney injury (AKI). The purpose of this study was to investigate the relationship between D-dimer and AKI in patients with RM following EHS. A retrospective study was performed on patients with EHS admitted to the intensive care unit over 10-year. Data including baseline clinical information at admission, vital organ dysfunction, and 90-day mortality were collected. A total of 84 patients were finally included, of whom 41 (48.8%) had AKI. AKI patients had more severe organ injury and higher 90-day mortality (34.1 0.0%, < 0.001) than non-AKI patients. Multivariate logistic analysis showed that D-dimer (OR 1.3, 95% CI 1.1-1.7, = 0.018) was an independent risk factor for AKI with RM following EHS. Curve fitting showed a curve relationship between D-dimer and AKI. Two-piecewise linear regression showed that D-dimer was associated with AKI in all populations (OR 1.3, 95% CI 1.2-1.5, < 0.001) when D-dimer <10.0 mg/L, in RM group (OR 1.3, 95% CI 1.1-1.5, < 0.001) when D-dimer >0.4 mg/L, in the non-RM group (OR 6.4, 95% CI 1.7-23.9, = 0.005) when D-dimer <1.3 mg/L and D-dimer did not increase the incidence of AKI in the non-RM group when D-dimer >1.3 mg/L. AKI is a life-threatening complication of RM following EHS. D-dimer is associated with AKI in critically ill patients with EHS. The relationship between D-dimer and AKI depends on whether RM is present or not.
横纹肌溶解症（RM）合并热射病（EHS）的患者常伴有凝血功能障碍和急性肾损伤（AKI）。本研究旨在探讨 EHS 后 RM 患者 D-二聚体与 AKI 的关系。对 10 年来入住重症监护病房的 EHS 患者进行回顾性研究。收集患者入院时的基本临床资料、重要器官功能障碍及 90 天死亡率等数据。最终共纳入 84 例患者，其中 41 例（48.8%）发生 AKI。AKI 患者器官损伤更严重，90 天死亡率更高（34.1%，P<0.001）。多因素 logistic 分析显示，D-二聚体（OR 1.3，95%CI 1.1-1.7，P=0.018）是 EHS 后合并 RM 患者发生 AKI 的独立危险因素。曲线拟合显示 D-二聚体与 AKI 之间存在曲线关系。两段线性回归显示，在 D-二聚体<10.0mg/L 时，D-二聚体与所有人群的 AKI 相关（OR 1.3，95%CI 1.2-1.5，P<0.001）；在 D-二聚体>0.4mg/L 时，D-二聚体与 RM 组 AKI 相关（OR 1.3，95%CI 1.1-1.5，P<0.001）；在 D-二聚体<1.3mg/L 时，D-二聚体与非 RM 组 AKI 相关（OR 6.4，95%CI 1.7-23.9，P=0.005）；在 D-二聚体>1.3mg/L 时，D-二聚体不会增加非 RM 组 AKI 的发生率。AKI 是 EHS 后 RM 的一种危及生命的并发症。D-二聚体与危重症 EHS 患者的 AKI 相关。D-二聚体与 AKI 的关系取决于是否存在 RM。
