CHRISTUS Mother Frances Hospital - Tyler, 800 E. Dawson St., Tyler, TX, 75701, USA.
Department of Mathematics, The University of Texas at Tyler, Tyler, TX, USA.
Neurocrit Care. 2023 Feb;38(1):35-40. doi: 10.1007/s12028-022-01569-1. Epub 2022 Aug 3.
Augmented renal clearance (ARC) is a phenomenon that has been demonstrated in many subsets of critically ill patients and is characterized by a creatinine clearance (CrCl) > 130 mL/min. Prior research has examined ARC prevalence in the presence of sepsis, traumatic brain injury, subarachnoid hemorrhage, and intracranial hemorrhage. However, to our knowledge, no studies have examined whether this phenomenon occurs in patients suffering from an acute ischemic stroke (AIS). The objective of this study was to evaluate whether patients experiencing an AIS exhibit ARC, identify potential contributing factors, and examine the precision of current renal clearance estimation methods in patients with AIS experiencing ARC.
This was a single-center prospective observational study conducted in adult patients admitted to a neurocritical intensive care unit (ICU) at a community hospital. Once consent was gained, patients with an admitting diagnosis of an AIS underwent a 24-h urine collection to assess measured CrCl. The primary end point assessed for ARC, defined as a measured CrCl > 130 mL/min. The secondary end point evaluated length of stay in the neurocritical ICU.
Twenty-eight patients met enrollment criteria, and data was analyzed for 20 patients. ARC was present in 35% of enrolled patients. Mathematical estimations of renal function were inadequate in detecting ARC manifestation. Patients experiencing ARC were associated with nonsignificantly shorter ICU length of stay.
ARC appears to manifest in patients with AIS inconsistently. Patients experiencing ARC were associated with nonsignificantly shorter ICU length of stay.
增强的肾清除率（ARC）是一种已在许多危重症患者亚组中表现出的现象，其特征为肌酐清除率（CrCl）>130 mL/min。先前的研究已经检查了脓毒症、创伤性脑损伤、蛛网膜下腔出血和颅内出血患者中 ARC 的患病率。但是，据我们所知，尚无研究检查过这种现象是否发生在患有急性缺血性脑卒中（AIS）的患者中。本研究的目的是评估经历 AIS 的患者是否表现出 ARC，确定潜在的促成因素，并检查在经历 ARC 的 AIS 患者中当前肾清除率估计方法的精确性。
这是一项在社区医院神经重症监护病房（NICU）中进行的单中心前瞻性观察性研究。一旦获得同意，患有 AIS 入院诊断的患者进行 24 小时尿液收集以评估实测 CrCl。评估的主要终点为 ARC，定义为实测 CrCl>130 mL/min。次要终点评估 NICU 住院时间。
28 名患者符合纳入标准，对 20 名患者进行了数据分析。35%的纳入患者出现 ARC。肾功能的数学估计不足以检测到 ARC 的表现。出现 ARC 的患者 ICU 住院时间无显著缩短。
ARC 似乎在 AIS 患者中表现不一致。出现 ARC 的患者 ICU 住院时间无显著缩短。
