Lin Jin, Zhuang Hai Zhou, Zhi De Yuan, Qi Zhili, Bai Jing, Dong Lei, Liu Shuai, Duan Meili
Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Med (Lausanne). 2021 Nov 15;8:762112. doi: 10.3389/fmed.2021.762112. eCollection 2021.
The clinicians often use continuous renal replacement therapy (CRRT) for the fluid management of patients with septic acute kidney injury (AKI). However, there is limited knowledge of the effects of changes in fluid balance (FB) on CRRT and its association with outcomes in patients with septic AKI. This study aimed to determine the association of cumulative FB (CFB) during treatment with 28-day all-cause mortality in the patients with septic AKI who require CRRT. This retrospective observational study examined patients who received CRRT due to septic AKI in a mixed intensive care unit (ICU) of a tertiary teaching hospital between January 2015 and December 2018. The patients were divided into three groups-negative FB, even FB, and positive FB-based on the CFB during CRRT. The primary outcome was 28-day all-cause mortality. We examined 227 eligible patients and the mean age was 62.4 ± 18.3 years. The even FB group had a significantly lower 28-day mortality (43.0%, = 0.007) than the positive FB group (72.7%) and the negative FB group (54.8%). The unadjusted and adjusted Cox regression models indicated that the positive FB group had an increased risk for 28-day all-cause mortality relative to the even FB group. A restricted cubic splines model indicated a J-shaped association between the CFB and 28-day all-cause mortality in the unadjusted model. Among the critically ill patients with septic AKI who require CRRT, those with positive FB had a higher mortality rate than those with even FB.
临床医生经常使用连续性肾脏替代疗法（CRRT）对脓毒症急性肾损伤（AKI）患者进行液体管理。然而，关于液体平衡（FB）变化对CRRT的影响及其与脓毒症AKI患者预后的关联，人们了解有限。本研究旨在确定接受CRRT的脓毒症AKI患者治疗期间累积FB（CFB）与28天全因死亡率之间的关联。这项回顾性观察性研究考察了2015年1月至2018年12月期间在一家三级教学医院的混合重症监护病房（ICU）因脓毒症AKI接受CRRT的患者。根据CRRT期间的CFB，将患者分为三组——负FB组、平衡FB组和正FB组。主要结局是28天全因死亡率。我们研究了227例符合条件的患者，平均年龄为62.4±18.3岁。平衡FB组的28天死亡率（43.0%， = 0.007）显著低于正FB组（72.7%）和负FB组（54.8%）。未调整和调整后的Cox回归模型表明，相对于平衡FB组，正FB组28天全因死亡风险增加。限制立方样条模型表明，在未调整模型中，CFB与28天全因死亡率之间呈J形关联。在需要CRRT的脓毒症AKI重症患者中，正FB患者的死亡率高于平衡FB患者。
