Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Mathematics, Halicioglu Data Science Institute, University of California, San Diego, La Jolla, California.
Ann Thorac Surg. 2024 Feb;117(2):432-438. doi: 10.1016/j.athoracsur.2023.07.011. Epub 2023 Jul 23.
As patients with acute kidney injury (AKI) progress to a higher stage, the risk for poor outcomes dramatically rises. Early identification of patients at high risk for AKI progression remains a major challenge. This study aimed to evaluate the value of furosemide responsiveness (FR) for predicting AKI progression in patients with initial mild and moderate AKI after cardiac surgery.
We performed 2 separate exploratory analyses. The Zhongshan cohort was a single-center, prospective, observational cohort, whereas the Beth Israel Deaconess Medical Center cohort was a single-center, retrospective cohort. We calculated 2 FR parameters for each patient, namely the FR index and modified FR index, defined as 2-hour urine output divided by furosemide dose (FR index, mL/mg/2 h) and by furosemide dose and body weight (modified FR index, mL/[mg·kg]/2 h), respectively. The primary outcome was AKI progression within 7 days.
AKI progression occurred in 80 (16.0%) and 359 (11.3%) patients in the Zhongshan and Beth Israel Deaconess Medical Center cohorts, respectively. All FR parameters (considered continuously or in quartiles) were inversely associated with risk of AKI progression in both cohorts (all adjusted P < .01). The addition of FR parameters significantly improved prediction for AKI progression based on baseline clinical models involving C-index, net reclassification improvement, and integrated discrimination improvement index in both cohorts (all P < .01).
FR parameters were inversely associated with risk of AKI progression in patients with mild and moderate AKI after cardiac surgery. The addition of FR parameters significantly improved prediction for AKI progression based on baseline clinical models.
随着急性肾损伤（AKI）患者病情进展至更高阶段，其不良结局的风险显著增加。早期识别 AKI 进展风险较高的患者仍然是一个主要挑战。本研究旨在评估速尿反应性（FR）在预测心脏手术后初始轻度和中度 AKI 患者 AKI 进展中的价值。
我们进行了 2 项独立的探索性分析。中山队列是一项单中心、前瞻性、观察性队列研究，而 Beth Israel Deaconess Medical Center 队列是一项单中心、回顾性队列研究。我们为每位患者计算了 2 个 FR 参数，即 FR 指数和改良 FR 指数，定义为 2 小时尿量除以速尿剂量（FR 指数，mL/mg/2 h）和速尿剂量与体重（改良 FR 指数，mL/[mg·kg]/2 h）。主要结局为 7 天内 AKI 进展。
中山和 Beth Israel Deaconess Medical Center 队列中 AKI 进展分别发生在 80（16.0%）和 359（11.3%）例患者中。所有 FR 参数（连续或分为 quartiles 考虑）均与两个队列中 AKI 进展风险呈负相关（所有调整后的 P <.01）。在两个队列中，基于基线临床模型（包括 C 指数、净重新分类改善和综合判别改善指数），FR 参数的添加显著改善了 AKI 进展的预测（均 P <.01）。
FR 参数与心脏手术后轻度和中度 AKI 患者 AKI 进展风险呈负相关。基于基线临床模型，FR 参数的添加显著改善了 AKI 进展的预测。
