Yajima Wataru, Aso Shotaro, Matsui Hiroki, Fushimi Kiyohide, Yasunaga Hideo
Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan.
Department of Emergency Medicine, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan.
J Intensive Care. 2025 Apr 27;13(1):22. doi: 10.1186/s40560-025-00788-w.
Although experts recommend intravenous fluid (IVF) for patients with rhabdomyolysis to prevent renal injury, the optimal IVF volume remains unknown because excessive IVF may lead to organ edema, resulting in organ injury. This study aimed to investigate the association between IVF volume and the composite outcome of hemodialysis dependence or in-hospital death in patients with rhabdomyolysis.
We retrospectively identified patients with rhabdomyolysis admitted to intensive care units and tertiary-care hospitals from July 2010 to March 2022 using the Japanese Diagnosis Procedure Combination database. We divided the patients into those who received at least 3500 mL/day of IVF within 3 days of admission and those who did not. This threshold was defined based on the findings of previous studies. We compared the composite outcome, including hemodialysis dependence at discharge and in-hospital death, between the groups using propensity score overlap weighting.
We identified 5392 eligible patients. Of those, 1677 (31.1%) received ≥ 3500 mL/day of IVF, and 3715 (68.9%) received < 3500 mL/day of IVF; the total volumes of IVF within 3 days of admission were 11,039 mL and 4054 mL, respectively. Propensity-score overlap weighting created balanced cohorts, which did not show significant difference in primary composite outcome between the groups (3.4% vs. 3.9%; risk difference [RD] - 0.4, 95% confidence interval [CI] - 1.8 to 0.9, P = 0.53). The proportion of hemodialysis dependence was lower in the IVF ≥ 3500 mL/day group than those in the < 3500 mL/day group (0.4% vs. 1.3%; RD - 0.9, 95% CI - 1.6 to - 0.2, P = 0.02).
This retrospective database study found that IVF ≥ 3500 mL/day for patients with rhabdomyolysis was not associated with a reduction in the composite outcome but was associated with a reduction in hemodialysis dependence at discharge. The optimal IVF volume still remains unknown, and further studies are warranted.
尽管专家建议对横纹肌溶解症患者静脉输注液体（IVF）以预防肾损伤，但最佳的IVF量仍不清楚，因为过量的IVF可能导致器官水肿，进而造成器官损伤。本研究旨在调查横纹肌溶解症患者的IVF量与血液透析依赖或住院死亡这一复合结局之间的关联。
我们利用日本诊断流程组合数据库，回顾性地确定了2010年7月至2022年3月期间入住重症监护病房和三级医院的横纹肌溶解症患者。我们将患者分为入院3天内接受至少3500毫升/天IVF的患者和未接受的患者。该阈值是根据先前研究的结果确定的。我们使用倾向得分重叠加权法比较了两组之间的复合结局，包括出院时的血液透析依赖和住院死亡情况。
我们确定了5392例符合条件的患者。其中，1677例（31.1%）接受≥3500毫升/天的IVF，3715例（68.9%）接受<3500毫升/天的IVF；入院3天内的IVF总量分别为11039毫升和4054毫升。倾向得分重叠加权法创建了平衡的队列，两组之间的主要复合结局没有显著差异（3.4%对3.9%；风险差异[RD] -0.4，95%置信区间[CI] -1.8至0.9，P = 0.53）。IVF≥3500毫升/天组的血液透析依赖比例低于<3500毫升/天组（0.4%对1.3%；RD -0.9，95% CI -1.6至-0.2，P = 0.02）。
这项回顾性数据库研究发现，横纹肌溶解症患者每天接受≥3500毫升IVF与复合结局的降低无关，但与出院时血液透析依赖的降低有关。最佳的IVF量仍然未知，有必要进行进一步研究。
