Chen Weixiao, Chen Qingzhou, Wang Yuli, Yang Qilin, Chen Weiyan, Tao Lili, Zheng Jiezhao, Wen Deliang, Zhang Zhenhui
Department of Intensive Care Unit, Guangzhou Key Laboratory of Prevention and Treatment of Multiple Organ Dysfunction Syndrome, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China.
Sci Rep. 2025 Jul 22;15(1):26612. doi: 10.1038/s41598-025-11175-8.
Mannitol is widely used for treating brain edema caused by various diseases, but it has been reported to cause acute kidney injury. However, the prognosis for patients with non-traumatic intracerebral hemorrhage who also have acute kidney injury and continue to receive mannitol has not yet been documented. This study presents a retrospective cohort analysis utilizing the MIMIC-IV (medical information mart for intensive care-IV) database. The study population comprised adult patients diagnosed with non-traumatic intracerebral hemorrhage (ICH) and concurrent acute kidney injury (AKI). Mannitol administration during the intensive care unit (ICU) stay was considered the exposure variable. The primary endpoint for analysis was 28-day all-cause mortality. To account for potential confounding factors, multivariable analytical methods were employed. The 28-day mortality rate within the total cohort was 25%. In the mannitol group, the 28-day mortality rate was 50.4% (58/115), compared to 21.9% (203/927) in the control group. Mannitol use was associated with a significantly higher 28-day all-cause mortality in both the multivariable analysis (HR 2.42; 95% CI 1.80-3.25; p < 0.001) and the univariable analysis (HR 2.31; 95% CI 1.67-3.19; p < 0.001). Other variables independently associated with mortality included higher heart rate, mean arterial pressure, respiratory rate, platelet count, sodium, chloride, lactate, urea nitrogen, creatinine, SAPSII, SOFA, GCS, and Charlson Index. The in-hospital mortality rate was 47.8% (55 out of 115) in the mannitol treatment group and 16.2% (150 out of 927) in the non-treatment group. Mannitol use was associated with higher 28-day all-cause mortality in patients with non-traumatic ICH and AKI. However, given the methodological limitations and incomplete confounder adjustment of this study, this finding should be interpreted with caution. Further research is needed to confirm this relationship and explore the underlying mechanisms.
甘露醇被广泛用于治疗各种疾病引起的脑水肿，但据报道它会导致急性肾损伤。然而，对于同时患有急性肾损伤且继续接受甘露醇治疗的非创伤性脑出血患者的预后情况，目前尚无文献记载。本研究利用MIMIC-IV（重症监护医学信息数据库-IV）数据库进行了一项回顾性队列分析。研究人群包括被诊断为非创伤性脑出血（ICH）并并发急性肾损伤（AKI）的成年患者。在重症监护病房（ICU）住院期间使用甘露醇被视为暴露变量。分析的主要终点是28天全因死亡率。为了考虑潜在的混杂因素，采用了多变量分析方法。整个队列的28天死亡率为25%。在甘露醇组中，28天死亡率为50.4%（58/115），而对照组为21.9%（203/927）。在多变量分析（HR 2.42；95%CI 1.80 - 3.25；p＜0.001）和单变量分析（HR 2.31；95%CI 1.67 - 3.19；p＜0.001）中，使用甘露醇均与显著更高的28天全因死亡率相关。其他与死亡率独立相关的变量包括更高的心率、平均动脉压、呼吸频率、血小板计数、钠、氯、乳酸、尿素氮、肌酐、SAPSII、SOFA、GCS和Charlson指数。甘露醇治疗组的院内死亡率为47.8%（115例中的55例），非治疗组为16.2%（927例中的150例）。在非创伤性ICH和AKI患者中，使用甘露醇与更高的28天全因死亡率相关。然而，鉴于本研究的方法学局限性和混杂因素调整不完整，这一发现应谨慎解读。需要进一步的研究来证实这种关系并探索潜在机制。
