严重创伤危重症患者肾小球滤过率估算方程与 4 小时尿肌酐清除率的一致性。

Concordance between glomerular filtration rate estimation equations and 4-hour urinary creatinine clearance in critically ill patients with severe trauma.

机构信息

Área de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.

Área de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.

出版信息

Rev Esp Anestesiol Reanim (Engl Ed). 2023 Aug-Sep;70(7):381-386. doi: 10.1016/j.redare.2023.01.003. Epub 2023 Aug 2.

DOI:10.1016/j.redare.2023.01.003

PMID:37541328

Abstract

BACKGROUND AND OBJECTIVE

There is a growing body of evidence that the equations used to estimate the glomerular filtration rate (GFR) are not suitable in critically ill patients, a population whose GFR fluctuates continuously. Glomerular filtration is usually estimated by measuring urine creatinine clearance (CrCl) at various time points. The aim of our study was to evaluate the performance of the most widely used GFR calculators in the subpopulation of critically ill patients admitted for severe trauma, and to compare the results against determinations of CrCl in urine collected over a 4-h period (4h-CrCl).

MATERIAL AND METHODS

Observational study in patients hospitalized for severe trauma. We measured the 4h-CrCl and estimated GFR using the Cockcroft-Gault, modified Jelliffe, MDRD, t-MDRD, and CKD-EPI equations, adjusting the results for body surface area (BSA) (ml/min/1.73m). Data were analysed using R version 4.0.4.

RESULTS

A total of 85 patients were included. Median age was 51 years, and 68 were men (78.82%). The mean BSA-adjusted 4h-CrCl (4h-ClCr/1.73m) was 84.5 ml/min/1.73m. We found that GFR estimated using the t-MDRD equation correlated significantly with 4h-CrCl/1.73m. The Cockcroft-Gault equation correlated significantly with 4h-CrCl/1.73m when GFR was greater than 130ml/min/m.

CONCLUSIONS

In ICU patients, glomerular filtration can be reliably estimated by determining urine CrCl, but GFR calculators are not accurate in this population.

摘要

背景与目的

越来越多的证据表明，用于估计肾小球滤过率（GFR）的方程在危重症患者中并不适用，这些患者的 GFR 持续波动。肾小球滤过通常通过在不同时间点测量尿肌酐清除率（CrCl）来估计。我们的研究目的是评估最广泛使用的 GFR 计算器在因严重创伤住院的危重症患者亚组中的表现，并将结果与 4 小时收集的尿 CrCl（4h-CrCl）的测定结果进行比较。

材料与方法

这是一项对因严重创伤住院的患者进行的观察性研究。我们测量了 4h-CrCl，并使用 Cockcroft-Gault、改良 Jelliffe、MDRD、t-MDRD 和 CKD-EPI 方程估计 GFR，将结果调整为体表面积（BSA）（ml/min/1.73m）。使用 R 版本 4.0.4 分析数据。

结果

共纳入 85 例患者。中位年龄为 51 岁，68 例为男性（78.82%）。平均 BSA 调整的 4h-CrCl（4h-ClCr/1.73m）为 84.5 ml/min/1.73m。我们发现，当 GFR 大于 130ml/min/m 时，t-MDRD 方程估计的 GFR 与 4h-CrCl/1.73m 显著相关。当 GFR 大于 130ml/min/m 时，Cockcroft-Gault 方程与 4h-CrCl/1.73m 显著相关。