Wang Meiping, Zhu Bo, Jiang Li, Luo Xuying, Wang Na, Zhu Yibing, Xi Xiuming
Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China.
Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
Kidney Dis (Basel). 2021 Jul 15;8(1):82-92. doi: 10.1159/000515533. eCollection 2022 Jan.
We aimed to identify different trajectories of fluid balance (FB) and investigate the effect of FB trajectories on clinical outcomes in intensive care unit (ICU) patients with acute kidney injury (AKI) and the dose-response association between fluid overload (FO) and mortality.
We derived data from the Beijing Acute Kidney Injury Trial (BAKIT). A total of 1,529 critically ill patients with AKI were included. The primary outcome was 28-day mortality, and hospital mortality, ICU mortality and AKI stage were the secondary outcomes. A group-based trajectory model was used to identify the trajectory of FB during the first 7 days. Multivariable logistic regression was performed to examine the relationship between FB trajectories and clinical outcomes. A logistic regression model with restricted cubic splines was used to examine the dose relationship between FO and 28-day mortality.
Three distinct trajectories of FB were identified: low FB (1,316, 86.1%), decreasing FB (120, 7.8%), and high FB (93, 6.1%). Compared with low FB, high FB was associated with increased 28-day mortality (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.17-3.19) and AKI stage (OR 2.04, 95% CI 1.23-3.37), whereas decreasing FB was associated with a reduction in 28-day mortality by approximately half (OR 0.53, 95% CI 0.32-0.87). Similar results were found for the outcomes of ICU mortality and hospital mortality. We observed a J-shaped relationship between maximum FO and 28-day mortality, with the lowest risk at a maximum FO of 2.8% L/kg.
Different trajectories of FB in critically ill patients with AKI were associated with clinical outcomes. An FB above or below a certain range was associated with an increased risk of mortality. Further studies should explore this relationship and search for the optimal fluid management strategies for critically ill patients with AKI.
我们旨在确定液体平衡（FB）的不同轨迹，并研究FB轨迹对急性肾损伤（AKI）的重症监护病房（ICU）患者临床结局的影响，以及液体超负荷（FO）与死亡率之间的剂量反应关系。
我们从北京急性肾损伤试验（BAKIT）中获取数据。共纳入1529例重症AKI患者。主要结局为28天死亡率，次要结局为医院死亡率、ICU死亡率和AKI分期。采用基于组的轨迹模型来确定前7天的FB轨迹。进行多变量逻辑回归以检验FB轨迹与临床结局之间的关系。使用带有受限立方样条的逻辑回归模型来检验FO与28天死亡率之间的剂量关系。
确定了三种不同的FB轨迹：低FB（1316例，86.1%）、下降FB（120例，7.8%）和高FB（93例，6.1%）。与低FB相比，高FB与28天死亡率增加（比值比[OR]1.94，95%置信区间[CI]1.17 - 3.19）和AKI分期增加（OR 2.04，95%CI 1.23 - 3.37）相关，而下降FB与28天死亡率降低约一半相关（OR 0.53，95%CI 0.32 - 0.87）。在ICU死亡率和医院死亡率结局方面也发现了类似结果。我们观察到最大FO与28天死亡率之间呈J形关系，最大FO为2.8%L/kg时风险最低。
AKI重症患者的不同FB轨迹与临床结局相关。高于或低于一定范围的FB与死亡率增加风险相关。进一步的研究应探索这种关系，并寻找AKI重症患者的最佳液体管理策略。
