Cui Xiaoyang, Huang Xu, Yu Xin, Cai Ying, Tian Ye, Zhan Qingyuan
Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
Front Med (Lausanne). 2022 Sep 20;9:987437. doi: 10.3389/fmed.2022.987437. eCollection 2022.
We assessed the incidence and clinical characteristics of acute kidney injury (AKI) in acute respiratory distress syndrome (ARDS) patients and its effect on clinical outcomes.
We conducted a single-center prospective longitudinal study. Patients who met the Berlin definition of ARDS in the medical ICU in China-Japan Friendship Hospital from March 1, 2016, to September 30, 2020, were included. AKI was defined according to the KDIGO clinical practice guidelines. Early and late AKI were defined as AKI occurring within 48 h after ARDS was diagnosed or after 48 h, respectively.
Of the 311 ARDS patients, 161 (51.8%) developed AKI after ICU admission. Independent risk factors for AKI in ARDS patients were age (OR 1.027, 95% CI 1.009-1.045), a history of diabetes mellitus (OR 2.110, 95%CI 1.100-4.046) and chronic kidney disease (CKD) (OR 9.328, 95%CI 2.393-36.363), APACHE II score (OR 1.049, 95%CI 1.008-1.092), average lactate level in the first 3 days (OR 1.965, 95%CI 1.287-3.020) and using ECMO support (OR 2.359, 95%CI 1.154-4.824). Early AKI was found in 91 (56.5%) patients and late AKI was found in 70 (43.5%). Early AKI was related to the patient's underlying disease and the severity of hospital admission, while late AKI was related to the application of nephrotoxic drugs. The mortality rate of ARDS combined with AKI was 57.1%, which was independently associated with shock (OR 54.943, 95%CI 9.751-309.573).
A significant number of patients with ARDS developed AKI, and the mortality rate for ARDS patients was significantly higher when combined with AKI. Therapeutic drug monitoring should be routinely used to avoid drug toxicity during treatment.
我们评估了急性呼吸窘迫综合征（ARDS）患者急性肾损伤（AKI）的发病率、临床特征及其对临床结局的影响。
我们开展了一项单中心前瞻性纵向研究。纳入2016年3月1日至2020年9月30日期间在中国-日本友好医院医学重症监护病房符合ARDS柏林定义的患者。AKI根据KDIGO临床实践指南进行定义。早期和晚期AKI分别定义为在ARDS诊断后48小时内或48小时后发生的AKI。
311例ARDS患者中，161例（51.8%）在入住重症监护病房后发生AKI。ARDS患者发生AKI的独立危险因素为年龄（比值比1.027，95%置信区间1.009-1.045）、糖尿病病史（比值比2.110，95%置信区间1.100-4.046）和慢性肾脏病（CKD）（比值比9.328，95%置信区间2.393-36.363）、急性生理与慢性健康状况评分系统II（APACHE II）评分（比值比1.049，95%置信区间1.008-1.092）、前3天的平均乳酸水平（比值比1.965，95%置信区间1.287-3.020）以及使用体外膜肺氧合（ECMO）支持（比值比2.359，95%置信区间1.154-4.824）。91例（56.5%）患者发生早期AKI，70例（43.5%）患者发生晚期AKI。早期AKI与患者的基础疾病及入院时的病情严重程度有关，而晚期AKI与肾毒性药物的应用有关。ARDS合并AKI患者的死亡率为57.1%，其与休克独立相关（比值比54.943，95%置信区间9.751-309.573）。
大量ARDS患者发生AKI，ARDS患者合并AKI时死亡率显著更高。治疗期间应常规进行治疗药物监测以避免药物毒性。
