连续性肾脏替代治疗的急性肾损伤患者酸中毒和死亡率的纵向轨迹。

Longitudinal trajectory of acidosis and mortality in acute kidney injury requiring continuous renal replacement therapy.

机构信息

Department of Internal Medicine, Seoul National University College of Medicine 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.

Department of Internal Medicine, Inje University College of Medicine, Busan, South Korea.

出版信息

BMC Nephrol. 2022 Dec 26;23(1):411. doi: 10.1186/s12882-022-03047-4.

DOI:10.1186/s12882-022-03047-4

PMID:36572862

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9792158/

Abstract

BACKGROUND

Acidosis frequently occurs in severe acute kidney injury (AKI), and continuous renal replacement therapy (CRRT) can control this pathologic condition. Nevertheless, acidosis may be aggravated; thus, monitoring is essential after starting CRRT. Herein, we addressed the longitudinal trajectory of acidosis on CRRT and its relationship with worse outcomes.

METHODS

The latent growth mixture model was applied to classify the trajectories of pH during the first 24 hours and those of C-reactive protein (CRP) after 24 hours on CRRT due to AKI (n = 1815). Cox proportional hazard models were used to calculate hazard ratios of all-cause mortality after adjusting multiple variables or matching their propensity scores.

RESULTS

The patients could be classified into 5 clusters, including the normally maintained groups (1st cluster, pH = 7.4; and 2nd cluster, pH = 7.3), recovering group (3rd cluster with pH values from 7.2 to 7.3), aggravating group (4th cluster with pH values from 7.3 to 7.2), and ill-being group (5th cluster, pH < 7.2). The pH clusters had different trends of C-reactive protein (CRP) after 24 hours; the 1st and 2nd pH clusters had lower levels, but the 3rd to 5th pH clusters had an increasing trend of CRP. The 1st pH cluster had the best survival rates, and the 3rd to 5th pH clusters had the worst survival rates. This survival difference was significant despite adjusting for other variables or matching propensity scores.

CONCLUSIONS

Initial trajectories of acidosis determine subsequent worse outcomes, such as mortality and inflammation, in patients undergoing CRRT due to AKI.

摘要

背景

酸中毒在重症急性肾损伤（AKI）中经常发生，连续肾脏替代治疗（CRRT）可以控制这种病理状态。然而，酸中毒可能会加重；因此，在开始 CRRT 后进行监测至关重要。在此，我们探讨了 CRRT 期间酸中毒的纵向轨迹及其与预后恶化的关系。

方法

应用潜在增长混合模型对 1815 例因 AKI 而行 CRRT 的患者在最初 24 小时内 pH 值的轨迹和 24 小时后 C-反应蛋白（CRP）的轨迹进行分类。使用 Cox 比例风险模型计算校正多个变量或匹配其倾向评分后的全因死亡率的风险比。

结果

患者可分为 5 个聚类，包括正常维持组（第 1 聚类，pH=7.4；第 2 聚类，pH=7.3）、恢复组（pH 值为 7.2 到 7.3 的第 3 聚类）、加重组（pH 值为 7.3 到 7.2 的第 4 聚类）和不适组（pH <7.2 的第 5 聚类）。24 小时后 pH 聚类的 CRP 有不同的趋势；第 1 聚类和第 2 聚类的 CRP 水平较低，但第 3 聚类至第 5 聚类的 CRP 呈上升趋势。第 1 聚类 pH 组的生存率最高，第 3 聚类至第 5 聚类 pH 组的生存率最差。尽管调整了其他变量或匹配了倾向评分，但这种生存差异仍然显著。