ICU 幸存者连续与间断肾脏替代治疗后的长期死亡率和健康相关生活质量：ICU 后生活质量研究的二次分析。

Long-Term Mortality and Health-Related Quality of Life After Continuous Versus Intermittent Renal Replacement Therapy in ICU Survivors: A Secondary Analysis of the Quality of Life After ICU Study.

机构信息

MEDCIDS - Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.

CINTESIS@RISE - Centre for Health Technology and Services Research & Associate Laboratory - Health Research Network, University of Porto, Porto, Portugal.

出版信息

J Intensive Care Med. 2024 Jul;39(7):636-645. doi: 10.1177/08850666231224392. Epub 2024 Jan 9.

DOI:10.1177/08850666231224392

PMID:38196312

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11151712/

Abstract

We assessed long-term outcomes in intensive care unit (ICU) survivors with acute kidney injury (AKI) submitted to intermittent or continuous renal replacement therapy (RRT) for comparisons between groups. The multicenter prospective cohort study included 195 adult ICU survivors with an ICU stay >72 h in 10 ICUs that had at least one episode of AKI treated with intermittent RRT (IRRT) or continuous RRT (CRRT) during ICU stay. The main outcomes were mortality and health-related quality of life (HRQoL). Hospital readmissions and physical dependence were also assessed. Regarding RRT, 83 (42.6%) patients received IRRT and 112 (57.4%) received CRRT. Despite the similarity regarding sociodemographic characteristics, pre-ICU state of health and type of admission between groups, the risk of death (23.5% vs 42.7%; < .001), the prevalence of sepsis (60.7%) and acute respiratory distress syndrome (17%) were higher at ICU admission among CRRT patients. The severity of critical illness was higher among CRRT patients, regarding the need for mechanical ventilation (75.0% vs 50.6%, = .002) and vasopressors (91.1% vs 63.9%, < .001). One year after ICU discharge, 67 of 195 ICU survivors died (34.4%) and, after adjustment for confounders, there were no significant differences in mortality when comparing IRRT and CRTT patients (34.9% vs 33.9%; .590), on HRQoL in both physical (41.9% vs 42.2%; = .926) and mental dimensions (57.6% vs 56.6%; = .340), and on the number of hospital readmissions and physical dependence. Our study suggests that among ICU survivors RRT modality (IRRT vs CRRT) in the ICU does not impact long-term outcomes after ICU discharge.

摘要

我们评估了接受间歇性或连续性肾脏替代治疗（RRT）的重症监护病房（ICU）急性肾损伤（AKI）幸存者的长期结局，以比较组间差异。这项多中心前瞻性队列研究纳入了 195 名 ICU 幸存者，这些患者在 10 家 ICU 中接受了至少一次 AKI 治疗，其中 83 名（42.6%）患者接受了间歇性 RRT（IRRT），112 名（57.4%）患者接受了连续性 RRT（CRRT）。主要结局是死亡率和健康相关生活质量（HRQoL）。还评估了医院再入院和身体依赖情况。关于 RRT，83 名（42.6%）患者接受了 IRRT，112 名（57.4%）患者接受了 CRRT。尽管两组间在社会人口学特征、ICU 前健康状况和入院类型方面相似，但 CRRT 患者的死亡风险（23.5%比 42.7%；<0.001）、脓毒症（60.7%）和急性呼吸窘迫综合征（17%）的发生率更高。CRRT 患者的危重病严重程度更高，需要机械通气（75.0%比 50.6%，=0.002）和血管加压素（91.1%比 63.9%，<0.001）的患者比例更高。在 ICU 出院后 1 年，195 名 ICU 幸存者中有 67 人死亡（34.4%），在校正混杂因素后，IRRT 和 CRRT 患者的死亡率无显著差异（34.9%比 33.9%；=.590），在物理和心理维度的 HRQoL 方面也无显著差异（41.9%比 42.2%；=0.926；57.6%比 56.6%；=0.340），在医院再入院次数和身体依赖方面也无显著差异。我们的研究表明，在 ICU 幸存者中，ICU 中 RRT 方式（IRRT 与 CRRT）并不影响 ICU 出院后的长期结局。