Zhu Xu, Xue Jing, Maimaitituerxun Rehanguli, Liu Yamin, Zhou Qiaoling, Zhou Quan, Zhao Shuangping, Xu Hui, Xie Hui, Dai Wenjie, Chen Wenhang
Department of Nephrology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
Department of Epidemiology and Health Statistics, College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, 410208, Hunan, China.
Sci Rep. 2025 Jul 1;15(1):20885. doi: 10.1038/s41598-025-05515-x.
The impact of glucocorticoid therapy on mortality and renal function recovery in patients with sepsis-associated acute kidney injury (SA-AKI) remains unclear. A multicenter retrospective study was conducted using data from the Medical Information Mart for Intensive Care (MIMIC)-IV and the electronic ICU Collaborative Research Database (eICU-CRD). Of 8,759 SA-AKI patients, 1,334 received glucocorticoids and 7,425 did not. After adjustment, glucocorticoid treatment was associated with an increased risk of ICU mortality (hazard ratio [HR] 1.23; 95% confidence interval [CI] 1.07-1.41; P = 0.004) and in-hospital mortality (HR 1.16; 95% CI 1.02-1.32; P = 0.021). However, no statistically significant association was found between glucocorticoid use and renal function recovery (odds ratio [OR] 0.98; 95% CI 0.85-1.13; P = 0.796). Subgroup analysis suggested that dexamethasone use was associated with improved renal function recovery (OR 1.55; 95% CI 1.02-2.35; P = 0.04). In critically ill patients with SA-AKI, glucocorticoid therapy was associated with increased ICU and in-hospital mortality, without significant benefits in overall renal function recovery. However, dexamethasone may be linked to better renal function recovery. Further validation through randomized controlled trials is warranted to clarify the potential benefits and risks of glucocorticoid therapy in SA-AKI.
糖皮质激素治疗对脓毒症相关性急性肾损伤（SA-AKI）患者死亡率和肾功能恢复的影响仍不明确。本研究利用重症监护医学信息数据库（MIMIC-IV）和电子重症监护协作研究数据库（eICU-CRD）的数据进行了一项多中心回顾性研究。在8759例SA-AKI患者中，1334例接受了糖皮质激素治疗，7425例未接受。经过调整后，糖皮质激素治疗与ICU死亡率增加（风险比[HR]1.23；95%置信区间[CI]1.07-1.41；P = 0.004）和住院死亡率增加（HR 1.16；95%CI 1.02-1.32；P = 0.021）相关。然而，未发现糖皮质激素使用与肾功能恢复之间存在统计学显著关联（优势比[OR]0.98；95%CI 0.85-1.13；P = 0.796）。亚组分析表明，使用地塞米松与肾功能恢复改善相关（OR 1.55；95%CI 1.02-2.35；P = 0.04）。在患有SA-AKI的危重症患者中，糖皮质激素治疗与ICU和住院死亡率增加相关，对总体肾功能恢复无显著益处。然而，地塞米松可能与更好的肾功能恢复有关。有必要通过随机对照试验进行进一步验证，以阐明糖皮质激素治疗在SA-AKI中的潜在益处和风险。
