Prasanna Mrudula, Shende Dilip, Ravikumar Rajathadri Hosur, Kashyap Lokesh, Datta Sudip Kumar, Vyas Surabhi, Ray Bikash Ranjan
Critical Care Medicine, Manipal Hospitals, Sarjapur Road, Bengaluru, India.
Department of Anaesthesiology, Pain Medicine and Critical Care Medicine, AIIMS, Room 5012, 5Th Floor, Academic Block, Aurobindo Marg, Ansari Nagar, New Delhi, 110029, India.
J Ultrasound. 2025 Jun 23. doi: 10.1007/s40477-025-01035-6.
Augmented renal clearance (ARC) is frequently observed in ICU patients and is associated with renal vascular changes. We hypothesized that the renal resistive index (RRI) could predict ARC. Secondary objectives included evaluating the correlation between RRI and creatinine clearance (CrCl), identifying risk factors for ARC, and assessing its impact on ICU outcomes such as length of stay and survival.
This prospective observational study included 108 adult ICU patients without kidney disease, enrolled within 24 h of admission. RRI measurement, 24-h CrCl, and ARC score calculation were performed on the first day of ICU stay. We analysed RRI's accuracy in predicting ARC and investigated associations with clinical variables and outcomes.
RRI demonstrated high predictive accuracy for ARC (AUROC: 0.897, 95% CI 0.836-0.958). ARC prevalence was 38.9%. Significant risk factors for ARC included younger age, SOFA score, vasopressor use, trauma-related admissions, and diuretic use. A moderate negative correlation between RRI and CrCl was observed (r = - 0.541, p < 0.001). RRI showed superior predictive performance compared to the ARC score (p = 0.0008). ARC did not significantly affect ICU length of stay but was associated with improved ICU survival.
RRI is a reliable predictor of ARC in ICU patients and can help identify patients at risk early. Combining RRI with risk factors such as age, trauma-related admissions, and severity of illness may improve ARC detection and guide therapeutic decisions.
强化肾清除率（ARC）在重症监护病房（ICU）患者中经常出现，且与肾血管变化有关。我们假设肾阻力指数（RRI）可以预测ARC。次要目标包括评估RRI与肌酐清除率（CrCl）之间的相关性，确定ARC的危险因素，并评估其对ICU结局（如住院时间和生存率）的影响。
这项前瞻性观察性研究纳入了108例无肾脏疾病的成年ICU患者，在入院后24小时内入组。在ICU住院的第一天进行RRI测量、24小时CrCl测定和ARC评分计算。我们分析了RRI预测ARC的准确性，并研究了其与临床变量和结局的关联。
RRI对ARC具有较高的预测准确性（曲线下面积：0.897，95%可信区间0.836-0.958）。ARC的患病率为38.9%。ARC的显著危险因素包括年轻、序贯器官衰竭评估（SOFA）评分、血管升压药的使用、创伤相关入院和利尿剂的使用。观察到RRI与CrCl之间存在中度负相关（r = -0.541，p < 0.001）。与ARC评分相比，RRI显示出更好的预测性能（p = 0.0008）。ARC对ICU住院时间没有显著影响，但与ICU生存率的提高有关。
RRI是ICU患者ARC的可靠预测指标，有助于早期识别有风险的患者。将RRI与年龄、创伤相关入院和疾病严重程度等危险因素相结合，可能会提高ARC的检测率并指导治疗决策。
