Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.
Department of Public Health, University of California, Irvine, USA.
BMC Emerg Med. 2022 Feb 28;22(1):32. doi: 10.1186/s12873-022-00589-6.
Sepsis has high incidence and fatality rates in intensive care units, often leading to renal failure. The effectiveness of continuous renal replacement therapy (CRRT) in sepsis-associated acute kidney injury (S-AKI) patients is currently uncertain.
Joint model was used to determine the association between CRRT and the lactate trajectory trend and how it correlated to 28-day mortality for S-AKI patient in ICU.
A retrospective study was applied to patients with sepsis and AKI, which were extracted from the MIMIC-III public database, with the endpoint being 28-day mortality. Every lactate level measurement within 28 days was observed and calculated using logarithms. Joint model combined the longitudinal analysis of the natural logarithm of the lactate level [log(lactate)] in longitudinal submodel and Cox regression by trajectory function, demonstrating the effects of CRRT on 28-day survival and log(lactate) changes, and its final relationship with the event status.
Among the 717 S-AKI patients, 157 received CRRT. CRRT was not associated with 28-day mortality. After adjustments, the relationship between CRRT use and log(lactate) elevation was statistically significant. The parameter estimation of CRRT and log(lactate) indicated that using CRRT will increase log(lactate) by 0.041 in S-AKI patients. The joint model also instigated a fixed association between changes in the lactate level and the event result, revealing an exp value of (0.755) = 2.12, indicating that an increase of one unit in log(lactate) will increase the risk of 28-day mortality 2.12-times.
There was no significant association between CRRT use and 28-day survival in S-AKI patients, and JM showed that CRRT use might be associated with elevation of longitudinal lactate levels. Therefore, additional attention should be paid to other treatments to control lactate levels when providing renal support for patients with S-AKI.
脓毒症在重症监护病房中的发病率和死亡率都很高，常导致肾衰竭。连续肾脏替代治疗（CRRT）在脓毒症相关急性肾损伤（S-AKI）患者中的疗效尚不确定。
采用联合模型确定 CRRT 与乳酸轨迹趋势之间的关系，并探讨其与 ICU 中 S-AKI 患者 28 天死亡率的相关性。
本研究采用回顾性队列研究方法，纳入来自 MIMIC-III 公共数据库的脓毒症合并 AKI 患者，以 28 天死亡率为终点。观察并计算 28 天内的每个乳酸水平测量值，并采用对数形式表示。联合模型将乳酸水平的自然对数（log(lactate)）的纵向分析纳入纵向子模型，通过轨迹函数纳入 Cox 回归，以显示 CRRT 对 28 天生存和 log(lactate)变化的影响，及其与事件状态的最终关系。
在 717 例 S-AKI 患者中，157 例接受了 CRRT。CRRT 与 28 天死亡率无相关性。校正后，CRRT 使用与 log(lactate)升高之间的关系具有统计学意义。CRRT 和 log(lactate)的参数估计表明，在 S-AKI 患者中，使用 CRRT 将使 log(lactate)增加 0.041。联合模型还表明，乳酸水平变化与事件结果之间存在固定关联，变化的对数（0.755）= 2.12，这表明 log(lactate)增加一个单位会使 28 天死亡率增加 2.12 倍。
CRRT 使用与 S-AKI 患者的 28 天生存率之间无显著关联，JM 表明 CRRT 使用可能与纵向乳酸水平升高有关。因此，在为 S-AKI 患者提供肾脏支持时，应注意其他治疗方法以控制乳酸水平。
