蛛网膜下腔出血的重症监护病房患者血清钙水平与急性肾损伤风险之间的关联：一项回顾性队列研究
Association between serum calcium level and the risk of acute kidney injury in ICU patients with subarachnoid hemorrhage: a retrospective cohort study.
作者信息
Zhao Zhenlin, Xiao Kuntai, Zhao Sirong, Liu Kangfeng, Huang Fu, Xiao Hua
机构信息
Department of Neurosurgery, The Huadu District People's Hospital of Guangzhou, Guangzhou, Guangdong, China.
Department of Critical Care Medicine, The Huadu District People's Hospital of Guangzhou, Guangzhou, Guangdong, China.
出版信息
Front Neurol. 2024 Dec 11;15:1433653. doi: 10.3389/fneur.2024.1433653. eCollection 2024.
AIM
This study aimed to evaluate the association between serum calcium level and the risk of acute kidney injury (AKI) in patients with subarachnoid hemorrhage (SAH).
METHODS
In this retrospective cohort study, data on adults from the Medical Information Mart for Intensive Care (MIMIC-III and MIMIC-IV) databases, spanning from 2008 to 2019, were extracted. In the logistic regression models, confounding variables, including age, white blood cell (WBC), systolic blood pressure (SBP), heart rate, blood urea nitrogen (BUN), glucose, international normalized ratio (INR), and the Charlson Comorbidity Index (CCI), were finally adjusted by stepwise regression. The outcome event was the occurrence of AKI after intensive care unit (ICU) admission. The univariate and multivariate logistic regression models were utilized to assess the association between serum calcium level and the risk of AKI in SAH patients, with odds ratios (ORs) and 95% confidence intervals (CIs). To further explore the association, subgroup analyses were performed, stratified by age, Glasgow Coma Scale (GCS) scores, drugs, and surgical methods.
RESULTS
A total of 1,128 patients with SAH were included in the study, of which 457 patients developed AKI. Low levels of serum calcium were significantly associated with a high risk of AKI in patients with SAH, with an OR (95%CI) of 1.38 (1.01-1.89). Further subgroup analyses showed that low levels of calcium were significantly associated with a high risk of AKI in SAH patients aged ≥60 years (OR = 0.27, 95%CI: 0.09-0.83), who had GCS score ≥13 (OR = 1.57, 95%CI: 1.08-2.30), who did not use calcium channel blockers (CCB) (OR = 2.22, 95%CI: 1.16-4.25) and angiotensin-converting enzyme (ACE) inhibitors (OR = 1.51, 95%CI: 1.06-2.14), and who did not undergo aneurysm embolization (OR = 1.48, 95%CI: 1.01-2.17) and aneurysm clipping (OR = 1.45, 95%CI: 1.04-2.01).
CONCLUSION
The results of our study indicated that low levels of serum calcium were significantly associated with the risk of AKI in patients with SAH.
目的
本研究旨在评估蛛网膜下腔出血（SAH）患者血清钙水平与急性肾损伤（AKI）风险之间的关联。
方法
在这项回顾性队列研究中，提取了2008年至2019年来自重症监护医学信息数据库（MIMIC-III和MIMIC-IV）的成年患者数据。在逻辑回归模型中，通过逐步回归最终调整了混杂变量，包括年龄、白细胞（WBC）、收缩压（SBP）、心率、血尿素氮（BUN）、血糖、国际标准化比值（INR）和Charlson合并症指数（CCI）。结局事件为重症监护病房（ICU）入院后发生AKI。采用单因素和多因素逻辑回归模型评估SAH患者血清钙水平与AKI风险之间的关联，并计算比值比（OR）和95%置信区间（CI）。为进一步探究这种关联，按年龄、格拉斯哥昏迷量表（GCS）评分、药物和手术方法进行了亚组分析。
结果
本研究共纳入1128例SAH患者，其中457例发生AKI。SAH患者血清钙水平低与AKI高风险显著相关，OR（95%CI）为1.38（1.01 - 1.89）。进一步的亚组分析表明，血清钙水平低与年龄≥60岁的SAH患者（OR = 0.27，95%CI：0.09 - 0.83）、GCS评分≥13的患者（OR = 1.57，95%CI：1.08 - 2.30）、未使用钙通道阻滞剂（CCB）的患者（OR = 2.22，95%CI：1.16 - 4.25）和血管紧张素转换酶（ACE）抑制剂的患者（OR = 1.51，95%CI：1.06 - 2.14）、未接受动脉瘤栓塞的患者（OR = 1.48，95%CI：1.01 - 2.17）以及未接受动脉瘤夹闭的患者（OR = 1.45，95%CI：1.04 - 2.01）的AKI高风险显著相关。
结论
我们的研究结果表明，SAH患者血清钙水平低与AKI风险显著相关。
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