Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, South Korea.
Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
Sci Rep. 2023 Feb 16;13(1):2796. doi: 10.1038/s41598-023-29926-w.
The association between fluid overload and survival has not been well elucidated in critically ill patients with sepsis-induced acute kidney injury (SIAKI) receiving continuous renal replacement therapy (CRRT). We investigated the optimal cutoff value of fluid overload for predicting mortality and whether minimizing fluid overload through CRRT is associated with a survival benefit in these patients. We examined 543 patients with SIAKI who received CRRT in our intensive care unit. The degree of cumulative fluid overload in relation to body weight was expressed as the percentage fluid overload (%FO). %FO was further subdivided into %FO from AKI diagnosis to CRRT initiation (%FOpreCRRT) and total fluid overload (%FOtotal). The best cutoff value of fluid overload for predicting the 28-day mortality was %FOpreCRRT > 4.6% and %FOtotal > 9.6%. Multivariable analysis demonstrated that patients with %FOpreCRRT > 4.6% and %FOtotal > 9.6% were 1.9 times and 3.37 times more likely to die than those with %FOpreCRRT ≤ 4.6% and %FOtotal ≤ 9.6%. The 28-day mortality was the highest in patients with %FOpreCRRT > 4.6% and %FOtotal > 9.6% (84.7%), followed by those with %FOpreCRRT ≤ 4.6% and %FOtotal > 9.6% (65.0%), %FOpreCRRT > 4.6% and %FOtotal ≤ 9.6% (43.6%), and %FOpreCRRT ≤ 4.6% and %FOtotal ≤ 9.6% (22%). This study demonstrated that fluid overload was independently associated with the 28-day mortality in critically ill patients with SIAKI. Future prospective studies are needed to determine whether minimizing fluid overload using CRRT improves the survival of these patients.
在接受连续性肾脏替代治疗 (CRRT) 的脓毒症相关性急性肾损伤 (SIAKI) 危重症患者中，液体超负荷与生存之间的关系尚未得到充分阐明。我们研究了液体超负荷的最佳截断值，以预测死亡率，以及通过 CRRT 最大限度地减少液体超负荷是否与这些患者的生存获益相关。我们检查了在我们的重症监护病房接受 CRRT 的 543 名 SIAKI 患者。与体重相关的累积液体超负荷程度用液体超负荷百分比（%FO）表示。%FO 进一步细分为 AKI 诊断至 CRRT 开始时的液体超负荷（%FOpreCRRT）和总液体超负荷（%FOtotal）。预测 28 天死亡率的最佳液体超负荷截断值为 %FOpreCRRT > 4.6%和%FOtotal > 9.6%。多变量分析表明，%FOpreCRRT > 4.6%和%FOtotal > 9.6%的患者比%FOpreCRRT ≤ 4.6%和%FOtotal ≤ 9.6%的患者死亡的可能性分别增加 1.9 倍和 3.37 倍。%FOpreCRRT > 4.6%和%FOtotal > 9.6%的患者 28 天死亡率最高（84.7%），其次是%FOpreCRRT ≤ 4.6%和%FOtotal > 9.6%（65.0%）、%FOpreCRRT > 4.6%和%FOtotal ≤ 9.6%（43.6%）和%FOpreCRRT ≤ 4.6%和%FOtotal ≤ 9.6%（22%）。这项研究表明，液体超负荷与 SIAKI 危重症患者的 28 天死亡率独立相关。需要进一步的前瞻性研究来确定使用 CRRT 最大限度地减少液体超负荷是否能改善这些患者的生存。
