Debora M. Hofer, Livio Ruzzante, Jan Waskowski, Anna S. Messmer, Carmen A. Pfortmueller
{"title":"积液对重症患者主要肾脏不良事件的影响--一项观察性队列研究","authors":"Debora M. Hofer, Livio Ruzzante, Jan Waskowski, Anna S. Messmer, Carmen A. Pfortmueller","doi":"10.1186/s13613-024-01281-7","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Fluid accumulation (FA) is known to be associated with acute kidney injury (AKI) during intensive care unit (ICU) stay but data on mid-term renal outcome is scarce. The aim of this study was to investigate the association between FA at ICU day 3 and major adverse kidney events in the first 30 days after ICU admission (MAKE30).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Retrospective, single-center cohort study including adult ICU patients with sufficient data to compute FA and MAKE30. We defined FA as a positive cumulative fluid balance greater than 5% of bodyweight. The association between FA and MAKE30, including its sub-components, as well as the serum creatinine trajectories during ICU stay were examined. In addition, we performed a sensitivity analysis for the stage of AKI and the presence of chronic kidney disease (CKD).</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Out of 13,326 included patients, 1,100 (8.3%) met the FA definition. FA at ICU day 3 was significantly associated with MAKE30 (adjusted odds ratio [aOR] 1.96; 95% confidence interval [CI] 1.67–2.30; <i>p</i> < 0.001) and all sub-components: need for renal replacement therapy (aOR 3.83; 95%CI 3.02–4.84), persistent renal dysfunction (aOR 1.72; 95%CI 1.40–2.12), and 30-day mortality (aOR 1.70; 95%CI 1.38–2.09), p all < 0.001. The sensitivity analysis showed an association of FA with MAKE30 independent from a pre-existing CKD, but exclusively in patients with AKI stage 3. Furthermore, FA was independently associated with the creatinine trajectory over the whole observation period.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Fluid accumulation is significantly associated with MAKE30 in critically ill patients. This association is independent from pre-existing CKD and strongest in patients with AKI stage 3.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":null,"pages":null},"PeriodicalIF":5.7000,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort study\",\"authors\":\"Debora M. Hofer, Livio Ruzzante, Jan Waskowski, Anna S. Messmer, Carmen A. Pfortmueller\",\"doi\":\"10.1186/s13613-024-01281-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Background</h3><p>Fluid accumulation (FA) is known to be associated with acute kidney injury (AKI) during intensive care unit (ICU) stay but data on mid-term renal outcome is scarce. The aim of this study was to investigate the association between FA at ICU day 3 and major adverse kidney events in the first 30 days after ICU admission (MAKE30).</p><h3 data-test=\\\"abstract-sub-heading\\\">Methods</h3><p>Retrospective, single-center cohort study including adult ICU patients with sufficient data to compute FA and MAKE30. We defined FA as a positive cumulative fluid balance greater than 5% of bodyweight. The association between FA and MAKE30, including its sub-components, as well as the serum creatinine trajectories during ICU stay were examined. In addition, we performed a sensitivity analysis for the stage of AKI and the presence of chronic kidney disease (CKD).</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>Out of 13,326 included patients, 1,100 (8.3%) met the FA definition. FA at ICU day 3 was significantly associated with MAKE30 (adjusted odds ratio [aOR] 1.96; 95% confidence interval [CI] 1.67–2.30; <i>p</i> < 0.001) and all sub-components: need for renal replacement therapy (aOR 3.83; 95%CI 3.02–4.84), persistent renal dysfunction (aOR 1.72; 95%CI 1.40–2.12), and 30-day mortality (aOR 1.70; 95%CI 1.38–2.09), p all < 0.001. The sensitivity analysis showed an association of FA with MAKE30 independent from a pre-existing CKD, but exclusively in patients with AKI stage 3. Furthermore, FA was independently associated with the creatinine trajectory over the whole observation period.</p><h3 data-test=\\\"abstract-sub-heading\\\">Conclusions</h3><p>Fluid accumulation is significantly associated with MAKE30 in critically ill patients. 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Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort study
Background
Fluid accumulation (FA) is known to be associated with acute kidney injury (AKI) during intensive care unit (ICU) stay but data on mid-term renal outcome is scarce. The aim of this study was to investigate the association between FA at ICU day 3 and major adverse kidney events in the first 30 days after ICU admission (MAKE30).
Methods
Retrospective, single-center cohort study including adult ICU patients with sufficient data to compute FA and MAKE30. We defined FA as a positive cumulative fluid balance greater than 5% of bodyweight. The association between FA and MAKE30, including its sub-components, as well as the serum creatinine trajectories during ICU stay were examined. In addition, we performed a sensitivity analysis for the stage of AKI and the presence of chronic kidney disease (CKD).
Results
Out of 13,326 included patients, 1,100 (8.3%) met the FA definition. FA at ICU day 3 was significantly associated with MAKE30 (adjusted odds ratio [aOR] 1.96; 95% confidence interval [CI] 1.67–2.30; p < 0.001) and all sub-components: need for renal replacement therapy (aOR 3.83; 95%CI 3.02–4.84), persistent renal dysfunction (aOR 1.72; 95%CI 1.40–2.12), and 30-day mortality (aOR 1.70; 95%CI 1.38–2.09), p all < 0.001. The sensitivity analysis showed an association of FA with MAKE30 independent from a pre-existing CKD, but exclusively in patients with AKI stage 3. Furthermore, FA was independently associated with the creatinine trajectory over the whole observation period.
Conclusions
Fluid accumulation is significantly associated with MAKE30 in critically ill patients. This association is independent from pre-existing CKD and strongest in patients with AKI stage 3.
期刊介绍:
Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.