Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
Department of Intensive Care, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Acta Anaesthesiol Scand. 2022 Nov;66(10):1219-1227. doi: 10.1111/aas.14133. Epub 2022 Sep 3.
Nephrocheck® was approved for acute kidney injury (AKI) risk assessment in critically illness. However, new studies suggest that urinary concentration affects Nephrocheck® and previous studies did not provide data on urinary output (UO) at the time of measurement.
We performed a prospective cohort study of the Nephrocheck® in intensive care unit patients fulfilling standard inclusion criteria. The primary outcome was Stage 2 or 3 AKI defined by both UO and creatinine Kidney Disease Improving Global Outcomes (KDIGO) criteria in the subsequent 12 h. The secondary outcome was the relationship of UO with Nephrocheck® measurement.
Among 98 patients, the primary outcome occurred in 53 (54.1%) overall, but in 23 (23.5%) by creatinine criteria alone. The median (interquartile range) Nephrocheck® in patients with subsequent Stage 2 or 3 AKI was greater than in Stage 1 or no-AKI patients (0.97 [0.48-1.99] vs. 0.46 [0.22-1.17]; p = .005). However, its area under the receiver characteristic curve was 0.66 (95% confidence interval [CI], 0.56-0.77). Moreover, Nephrocheck® was significantly and inversely correlated with UO (ρ = -.46, p < .001) at the time of measurement and, on a multivariable logistic regression, Nephrocheck® was not associated with subsequent Stage 2 or 3 AKI (OR 1.06 [95% CI, 0.74-1.53], p = .73). In contrast, the UO had an OR of 0.98 for each ml/h increase (95% CI, 0.97-1.00, p = .007).
Nephrocheck®'s predictive performance was limited and its value was inversely correlated with UO. Nephrocheck® had no independent relationship with outcome once UO at measurement was considered.
Nephrocheck® 已被批准用于评估危重病患者的急性肾损伤 (AKI) 风险。然而，新的研究表明，尿液浓缩会影响 Nephrocheck®，并且之前的研究没有提供测量时的尿液输出量 (UO) 数据。
我们对符合标准纳入标准的重症监护病房患者进行了 Nephrocheck® 的前瞻性队列研究。主要结局是在随后的 12 小时内根据 UO 和肌酐肾脏病改善全球结局 (KDIGO) 标准定义的 2 期或 3 期 AKI。次要结局是 UO 与 Nephrocheck® 测量的关系。
在 98 名患者中，主要结局总体发生率为 53 例（54.1%），但仅根据肌酐标准为 23 例（23.5%）。随后发生 2 期或 3 期 AKI 的患者的 Nephrocheck®中位数（四分位距）大于 1 期或无 AKI 患者（0.97 [0.48-1.99] vs. 0.46 [0.22-1.17]；p=0.005）。然而，其受试者工作特征曲线下面积为 0.66（95%置信区间 [CI]，0.56-0.77）。此外，Nephrocheck® 在测量时与 UO 呈显著负相关（ρ=-0.46，p<0.001），在多变量逻辑回归中，Nephrocheck®与随后的 2 期或 3 期 AKI 无关（OR 1.06 [95% CI，0.74-1.53]，p=0.73）。相比之下，UO 每增加 1 ml/h，OR 为 0.98（95% CI，0.97-1.00，p=0.007）。
Nephrocheck® 的预测性能有限，其价值与 UO 呈负相关。考虑到测量时的 UO 后，Nephrocheck®与结局没有独立关系。
