Division of Nephrology, Department of Medicine, Advanced Emergency and Critical Care Center, Kurume University Hospital, Kurume University School of Medicine, Fukuoka, Japan.
Department of Emergency and Critical Care Medicine, Advanced Emergency and Critical Care Center, Kurume University Hospital, Kurume University School of Medicine, Fukuoka, Japan.
World Neurosurg. 2024 Oct;190:e1093-e1099. doi: 10.1016/j.wneu.2024.08.077. Epub 2024 Aug 20.
Acute kidney injury (AKI) is a complication often observed in critically ill patients, indicating a worsening prognosis. However, factors predicting AKI in subarachnoid hemorrhage (SAH) patients are unclear. This study aims to elucidate the predictors of AKI occurrence.
All patients with SAH admitted to the intensive care unit between 2013 and 2019 were included. Patients with very severe SAH who are unsuitable to receive aggressive treatment, those who previously received a contrast medium at another medical institution within 24 hours before admission, and those on maintenance dialysis were excluded. We retrospectively examined blood tests conducted upon admission, oral medications administered, and the total amount of contrast medium used after initiating treatment to investigate their association with AKI occurrence.
Of the 254 SAH patients treated during the relevant period, 195 (median age 64 years, 72 males) met the inclusion/exclusion criteria, and 32 patients (16.3%) developed AKI. When multivariate analysis was performed using sex, uric acid level, and hemoglobin, which obtained P < 0.01 in the univariate analysis, as variables, only uric acid level was found as an independent predictor of AKI (odds ratio, 1.501; 95% confidence interval, 1.109-2.033, P value of 0.009). There was no difference in the occurrence of AKI between survivors and nonsurvivors (12/163 vs. 2/32, P = 0.824).
AKI occurred in 16.3% of the patients with SAH. Patients who developed AKI had significantly higher uric acid levels. SAH with high uric acid levels warrants attention for AKI.
急性肾损伤（AKI）是重症患者中常见的并发症，提示预后不良。然而，蛛网膜下腔出血（SAH）患者发生 AKI 的预测因素尚不清楚。本研究旨在阐明 AKI 发生的预测因素。
纳入 2013 年至 2019 年期间入住重症监护病房的所有 SAH 患者。排除非常严重的 SAH 患者（不适合接受积极治疗）、入院前 24 小时内在其他医疗机构接受过造影剂的患者以及接受维持性透析的患者。我们回顾性检查了入院时的血液检查、口服药物和开始治疗后使用的造影剂总量，以研究它们与 AKI 发生的关系。
在相关期间接受治疗的 254 例 SAH 患者中，195 例（中位年龄 64 岁，72 例男性）符合纳入/排除标准，32 例（16.3%）发生 AKI。在单变量分析中，性别、尿酸水平和血红蛋白水平均获得 P 值<0.01 的情况下，使用多变量分析，只有尿酸水平被发现是 AKI 的独立预测因素（比值比，1.501；95%置信区间，1.109-2.033，P 值为 0.009）。幸存者和非幸存者之间 AKI 的发生率没有差异（163 例中的 12 例与 32 例中的 2 例，P=0.824）。
SAH 患者中 AKI 的发生率为 16.3%。发生 AKI 的患者尿酸水平明显升高。尿酸水平高的 SAH 需要注意 AKI。
