Mele Alessandro, Cerminara Emanuele, Häbel Henrike, Rodriguez-Galvez Borja, Oldner Anders, Nelson David, Gårdh Johannes, Thobaben Ragnar, Jonmarker Sandra, Cronhjort Maria, Hollenberg Jacob, Mårtensson Johan
Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
Instituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy.
Ann Intensive Care. 2022 Jul 4;12(1):62. doi: 10.1186/s13613-022-01040-6.
Whether early fluid accumulation is a risk factor for adverse renal outcomes in septic intensive care unit (ICU) patients remains uncertain. We assessed the association between cumulative fluid balance and major adverse kidney events within 30 days (MAKE30), a composite of death, dialysis, or sustained renal dysfunction, in such patients.
We performed a multicenter, retrospective observational study in 1834 septic patients admitted to five ICUs in three hospitals in Stockholm, Sweden. We used logistic regression analysis to assess the association between cumulative fluid balance during the first two days in ICU and subsequent risk of MAKE30, adjusted for demographic factors, comorbidities, baseline creatinine, illness severity variables, haemodynamic characteristics, chloride exposure and nephrotoxic drug exposure. We assessed the strength of significant exposure variables using a relative importance analysis.
Overall, 519 (28.3%) patients developed MAKE30. Median (IQR) cumulative fluid balance was 5.3 (2.8-8.1) l in the MAKE30 group and 4.1 (1.9-6.8) l in the no MAKE30 group, with non-resuscitation fluids contributing to approximately half of total fluid input in each group. The adjusted odds ratio for MAKE30 was 1.05 (95% CI 1.02-1.09) per litre cumulative fluid balance. On relative importance analysis, the strongest factors regarding MAKE30 were, in decreasing order, baseline creatinine, cumulative fluid balance, and age. In the secondary outcome analysis, the adjusted odds ratio for dialysis or sustained renal dysfunction was 1.06 (95% CI 1.01-1.11) per litre cumulative fluid balance. On separate sensitivity analyses, lower urine output and early acute kidney injury, respectively, were independently associated with MAKE30, whereas higher fluid input was not.
In ICU patients with sepsis, a higher cumulative fluid balance after 2 days in ICU was associated with subsequent development of major adverse kidney events within 30 days, including death, renal replacement requirement, or persistent renal dysfunction.
在脓毒症重症监护病房（ICU）患者中，早期液体蓄积是否为不良肾脏结局的危险因素仍不确定。我们评估了此类患者30天内累积液体平衡与主要不良肾脏事件（MAKE30，包括死亡、透析或持续性肾功能不全的复合事件）之间的关联。
我们在瑞典斯德哥尔摩三家医院的五个ICU收治的1834例脓毒症患者中进行了一项多中心回顾性观察研究。我们使用逻辑回归分析评估ICU前两天的累积液体平衡与随后MAKE30风险之间的关联，并对人口统计学因素、合并症、基线肌酐、疾病严重程度变量、血流动力学特征、氯暴露和肾毒性药物暴露进行了校正。我们使用相对重要性分析评估显著暴露变量的强度。
总体而言，519例（28.3%）患者发生了MAKE30。MAKE30组的中位数（IQR）累积液体平衡为5.3（2.8 - 8.1）升，无MAKE30组为4.1（1.9 - 6.8）升，每组中未用于复苏的液体约占总液体输入量的一半。累积液体平衡每增加1升，MAKE30的校正比值比为(1.05)（95%CI 1.02 - 1.09）。在相对重要性分析中，与MAKE30相关的最强因素按降序排列为基线肌酐、累积液体平衡和年龄。在次要结局分析中，累积液体平衡每增加1升，透析或持续性肾功能不全的校正比值比为(1.06)（95%CI 1.01 - 1.11）。在单独的敏感性分析中，较低尿量和早期急性肾损伤分别与MAKE30独立相关，而较高的液体输入量则不然。
在脓毒症ICU患者中，ICU入住2天后累积液体平衡较高与随后30天内发生主要不良肾脏事件相关，包括死亡、肾脏替代治疗需求或持续性肾功能不全。
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