Lin Liangen, Sun Congcong, Xie Yuequn, Ye Yuanwen, Zhu Peng, Pan Keyue, Chen Linglong
Department of Emergency, The Third Affiliated to Shanghai University, Wenzhou People's Hospital, Wenzhou, Zhejiang 325000, China.
Department of Scientific Research Center, The Third Affiliated to Shanghai University, Wenzhou People's Hospital, Wenzhou, Zhejiang 325000, China.
Clin Biochem. 2024 Oct;131-132:110806. doi: 10.1016/j.clinbiochem.2024.110806. Epub 2024 Jul 26.
Serum lactate and creatinine levels upon admission in cardiac arrest (CA) patients significantly correlate with acute kidney injury (AKI) post-restoration of autonomic circulation. However, the association between serum lactate/creatinine ratio (LCR) and AKI in this population remains unclear. This study aimed to explore the relationship between LCR at admission and cardiac arrest-associated acute kidney injury (CA-AKI).
We conducted a secondary analysis of previously published data on CA patient resuscitation, categorizing them into tertiles based on LCR levels. Univariate and multivariate logistic regression models and subgroup analyses were employed to investigate the association between LCR and CA-AKI. Non-linear correlations were explored using restricted cubic splines, and a two-piece wise logistic proportional hazards model for both sides of the inflection point was constructed.
A total of 374 patients (72.19 % male) were included, with intensive care unit mortality, in-hospital mortality, and neurologic dysfunction rates of 51.87 %, 56.95 %, and 39.57 %, respectively. The overall CA-AKI incidence was 59.09 %. Multivariate logistic proportional hazards analysis revealed a negative association between LCR and CA-AKI incidence (adjusted odds ratio [OR] 0.85, 95 % confidence intervals [CI] = 0.78-0.93, P=0.001). Triple spline restriction analysis depicted an L-shaped correlation between baseline LCR and CA-AKI incidence. Particularly, a baseline LCR<0.051 was negatively associated with CA-AKI incidence (OR 0.494, 95 % CI=0.319-0.764, P=0.002). Beyond the LCR turning point, estimated dose-response curves remained consistent with a horizontal line.
Baseline LCR in CA patients exhibits an L-shaped correlation with AKI incidence following restoration of autonomic circulation. The threshold for CA-AKI is 0.051. This finding suggests that LCR may aid in identifying CA patients at high risk of AKI.
心脏骤停（CA）患者入院时的血清乳酸和肌酐水平与自主循环恢复后的急性肾损伤（AKI）显著相关。然而，该人群中血清乳酸/肌酐比值（LCR）与AKI之间的关联仍不明确。本研究旨在探讨入院时LCR与心脏骤停相关性急性肾损伤（CA-AKI）之间的关系。
我们对先前发表的关于CA患者复苏的数据进行了二次分析，根据LCR水平将患者分为三分位数。采用单因素和多因素逻辑回归模型以及亚组分析来研究LCR与CA-AKI之间的关联。使用受限立方样条探索非线性相关性，并构建拐点两侧的两段式逻辑比例风险模型。
共纳入374例患者（男性占72.19%），重症监护病房死亡率、住院死亡率和神经功能障碍发生率分别为51.87%、56.95%和39.57%。总体CA-AKI发生率为59.09%。多因素逻辑比例风险分析显示LCR与CA-AKI发生率呈负相关（调整后的优势比[OR]为0.85，95%置信区间[CI]=0.78-0.93，P=0.001）。三次样条限制分析描绘了基线LCR与CA-AKI发生率之间的L形相关性。特别是，基线LCR<0.051与CA-AKI发生率呈负相关（OR为0.494，95%CI=0.319-0.764，P=0.002）。超过LCR转折点后，估计的剂量反应曲线与水平线保持一致。
CA患者的基线LCR与自主循环恢复后的AKI发生率呈L形相关性。CA-AKI的阈值为0.051。这一发现表明LCR可能有助于识别有AKI高风险的CA患者。
