心脏手术后预测急性肾损伤的各种静脉充血替代标志物的比较：一项队列研究。

Comparison of various surrogate markers for venous congestion in predicting acute kidney injury following cardiac surgery: A cohort study.

作者信息

Li Zhi-Tao, Huang Da-Bing, Zhao Jian-Feng, Li Hui, Fu Shui-Qiao, Wang Wei

机构信息

Department of Surgical Intensive Care Unit, The First Affiliated Hospital, Zhejiang University, School of Medicine, China.

出版信息

J Crit Care. 2024 Feb;79:154441. doi: 10.1016/j.jcrc.2023.154441. Epub 2023 Oct 7.

DOI:10.1016/j.jcrc.2023.154441

PMID:37812993

Abstract

BACKGROUND

Venous congestion has been demonstrated to increase the risk of acute kidney injury (AKI) after cardiac surgery. Although many surrogate markers for venous congestion are currently used in clinical settings, there is no consensus on which marker is most effective in predicting AKI.

METHODS

We evaluated various markers of venous congestion, including central venous pressure (CVP), inferior vena cava (IVC) diameter, portal pulsatility fraction (PPF), hepatic vein flow pattern (HVF), intra-renal venous flow pattern (IRVF), and venous excess ultrasound grading score (VExUS) in adult patients undergoing cardiac surgery to compare their ability in predicting AKI.

RESULTS

Among the 230 patients enrolled in our study, 53 (23.0%) developed AKI, and 11 (4.8%) required continuous renal replacement therapy (CRRT). Our multivariate logistic analysis revealed that IRVF, PPF, HVF, and CVP were significantly associated with AKI, with IRVF being the strongest predictor (odds ratio [OR] 2.27; 95% confidence interval [CI], 1.38-3.73). However, we did not observe any association between these markers and CRRT.

CONCLUSION

Venous congestion is associated with AKI after cardiac surgery, but not necessarily with CRRT. Among the markers tested, IRVF exhibits the strongest correlation with AKI.

摘要

背景

静脉淤血已被证明会增加心脏手术后急性肾损伤（AKI）的风险。尽管目前临床中使用了许多静脉淤血的替代标志物，但对于哪种标志物在预测AKI方面最有效尚无共识。

方法

我们评估了成年心脏手术患者的各种静脉淤血标志物，包括中心静脉压（CVP）、下腔静脉（IVC）直径、门静脉搏动分数（PPF）、肝静脉血流模式（HVF）、肾内静脉血流模式（IRVF）以及静脉超声评分（VExUS），以比较它们预测AKI的能力。

结果

在我们研究纳入的230例患者中，53例（23.0%）发生了AKI，11例（4.8%）需要持续肾脏替代治疗（CRRT）。我们的多因素逻辑回归分析显示，IRVF、PPF、HVF和CVP与AKI显著相关，其中IRVF是最强的预测指标（比值比[OR]2.27；95%置信区间[CI]，1.38 - 3.73）。然而，我们未观察到这些标志物与CRRT之间存在任何关联。