呋塞米给药与接受肾脏替代治疗的脓毒症相关性急性肾损伤患者临床结局的相关性：基于 MIMIC-IV 数据库的回顾性观察性队列研究。

Association between furosemide administration and clinical outcomes in patients with sepsis-associated acute kidney injury receiving renal replacement therapy: a retrospective observational cohort study based on MIMIC-IV database.

机构信息

Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China.

Advertising Center, Tianjin Daily, Tianjin, China.

出版信息

BMJ Open. 2023 Jul 30;13(7):e074046. doi: 10.1136/bmjopen-2023-074046.

DOI:10.1136/bmjopen-2023-074046

PMID:37518073

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10387626/

Abstract

OBJECTIVE

To investigate the association between furosemide administration and clinical outcomes in patients with sepsis-associated acute kidney injury (SAKI) receiving renal replacement therapy (RRT).

DESIGN

A retrospective observational cohort study.

SETTING

The data were collected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, which contains clinical data from more than 380 000 patients admitted to the intensive care units (ICUs) of the Beth Israel Deaconess Medical Center from 2008 to 2019.

PARTICIPANTS

All adult patients with SAKI receiving RRT were enrolled. Data for each patient within the first 24 hours of ICU admission were extracted from the MIMIC-IV database.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was in-hospital mortality, and the secondary outcome was the length of hospital stay, length of ICU stay, RRT-free time and ventilator-free time. Logistic regression was used to investigate the association between furosemide administration and in-hospital mortality. Subgroup analysis was employed to explore the potential sources of heterogeneity.

RESULTS

A total of 1663 patients with SAKI receiving RRT were enrolled in the study, of whom 991 patients (59.6%) were retrospectively allocated to the Furosemide group and 672 (40.4%) patients to the non-furosemide group. Univariate and multivariate logistic regression showed that furosemide administration was associated with reduced in-hospital mortality, respectively ((OR 0.77; 95% CI 0.63 to 0.93; p=0.008 < 0.05), (OR 0.59; 95% CI 0.46 to 0.75; p<0.001)). The association remained robust to different ways of adjusting for baseline confounding (all p<0.05). Subgroup analysis suggested that AKI-stage may be a source of heterogeneity. Patients in the furosemide group also had longer RRT-free time (p<0.001) and longer ventilator-free time (p<0.001) than those in the non-furosemide group.

CONCLUSIONS

Furosemide is associated with decreased in-hospital mortality, longer RRT-free time and ventilator-free time in patients with SAKI receiving RRT.

摘要

目的

探讨在接受肾脏替代治疗（RRT）的脓毒症相关急性肾损伤（SAKI）患者中，呋塞米给药与临床结局的关系。

设计

回顾性观察队列研究。

设置

数据来自 Medical Information Mart for Intensive Care IV（MIMIC-IV）数据库，该数据库包含了 2008 年至 2019 年间 Beth Israel Deaconess 医疗中心 ICU 收治的 38 万多名患者的临床数据。

参与者

所有接受 RRT 的 SAKI 成年患者均被纳入研究。从 MIMIC-IV 数据库中提取每位患者 ICU 入院后 24 小时内的数据。

主要和次要结局测量

主要结局为院内死亡率，次要结局为住院时间、ICU 住院时间、RRT 无时间和呼吸机无时间。使用逻辑回归来研究呋塞米给药与院内死亡率之间的关系。采用亚组分析探讨潜在的异质性来源。

结果

共有 1663 名接受 RRT 的 SAKI 患者纳入研究，其中 991 名（59.6%）患者被回顾性分配到呋塞米组，672 名（40.4%）患者被分配到非呋塞米组。单变量和多变量逻辑回归显示，呋塞米给药与降低院内死亡率相关，分别为（OR 0.77；95%CI 0.63 至 0.93；p=0.008<0.05），（OR 0.59；95%CI 0.46 至 0.75；p<0.001））。不同方式调整基线混杂因素后，这种关联仍然稳健（均 p<0.05）。亚组分析表明，AKI 分期可能是异质性的一个来源。与非呋塞米组相比，呋塞米组的患者还具有更长的 RRT 无时间（p<0.001）和更长的呼吸机无时间（p<0.001）。