Chawalitpongpun Phaweesa, Kanchanasurakit Sukrit, Sanhatham Nattha, Sasom Warinda, Thanommim Siriwan, Senpradit Araya, Siriplabpla Wuttikorn
Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Mueang Phayao, Thailand.
Department of Pharmacy, Phrae Hospital, Mueang Phrae, Thailand.
Acute Crit Care. 2024 Aug;39(3):369-378. doi: 10.4266/acc.2024.00514. Epub 2024 Aug 30.
Normal saline is commonly used for resuscitation in sepsis patients but has a high chloride content, potentially increasing the risk of acute kidney injury (AKI). This study evaluated risk factors and developed a predictive risk score for AKI in sepsis patients treated with normal saline.
This retrospective cohort study utilized the medical and electronic health records of sepsis patients who received normal saline between January 2018 and May 2020. Predictors of AKI used to construct the predictive risk score were identified through multivariate logistic regression models, with discrimination and calibration assessed using the area under the receiver operating characteristic curve (AUROC) and the expected-to-observed (E/O) ratio. Internal validation was conducted using bootstrapping techniques.
AKI was reported in 211 of 735 patients (28.7%). Eight potential risk factors, including norepinephrine, the Acute Physiology and Chronic Health Evaluation II score, serum chloride, respiratory failure with invasive mechanical ventilation, nephrotoxic antimicrobial drug use, history of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers use, history of liver disease, and serum creatinine were used to create the NACl RENAL-Cr score. The model demonstrated good discrimination and calibration (AUROC, 0.79; E/O, 1). The optimal cutoff was 2.5 points, with corresponding sensitivity, specificity, positive predictive value, and negative predictive value scores of 71.6%, 72.5%, 51.2%, and 86.4%, respectively.
The NACl RENAL-Cr score, consisting of eight critical variables, was used to predict AKI in sepsis patients who received normal saline. This tool can assist healthcare professionals when deciding on sepsis treatment and AKI monitoring.
生理盐水常用于脓毒症患者的复苏，但氯含量高，可能增加急性肾损伤（AKI）的风险。本研究评估了脓毒症患者接受生理盐水治疗时AKI的危险因素，并制定了预测风险评分。
这项回顾性队列研究利用了2018年1月至2020年5月间接受生理盐水治疗的脓毒症患者的医疗和电子健康记录。通过多变量逻辑回归模型确定用于构建预测风险评分的AKI预测因素，并使用受试者操作特征曲线下面积（AUROC）和预期与观察（E/O）比值评估辨别力和校准度。使用自抽样技术进行内部验证。
735例患者中有211例（28.7%）报告发生AKI。八个潜在危险因素，包括去甲肾上腺素、急性生理与慢性健康状况评估II评分、血清氯、有创机械通气导致的呼吸衰竭、使用肾毒性抗菌药物、有血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂使用史、有肝病病史和血清肌酐，被用于创建NACl RENAL-Cr评分。该模型显示出良好的辨别力和校准度（AUROC，0.79；E/O，1）。最佳截断值为2.5分，相应的灵敏度、特异度、阳性预测值和阴性预测值分别为71.6%、72.5%、51.2%和86.4%。
由八个关键变量组成的NACl RENAL-Cr评分用于预测接受生理盐水治疗的脓毒症患者的AKI。该工具可协助医疗保健专业人员进行脓毒症治疗决策和AKI监测。
