急性肾损伤患者液体超负荷与预后的关系

Association between fluid overload and outcomes in patients with acute kidney injury

目的 探讨急性肾损伤(AKI)患者液体超负荷对预后的影响。方法 纳入2016年5月1日至2018年1月30日广东省深圳市第二人民医院重症监护病房(ICU)收治的入科诊断AKI患者。随访至28 d,根据患者生存情况分为存活组和死亡组。连续记录在ICU前3 d每日液体平衡量。比较2组基线资料。采用Cox回归方法分析患者28 d死亡的危险因素。采用Kaplan-Meier方法分析液体超负荷对患者28 d生存率的影响。结果 本研究共纳入入ICU诊断AKI患者133例,根据随访28 d患者生存情况分为存活组(87例)和死亡组(46例),28 d病死率为34.6%(46/133)。多因素Cox回归分析结果显示,患者急性生理学与慢性健康状况评分系统Ⅱ评分每增加1分,28 d死亡风险增加10.4%(P<0.001);男性、使用万古霉素、住院期间行肾脏替代治疗、入住ICU时及住院期间使用血管活性药物均增加患者28 d死亡风险(均P<0.05)。在ICU前3 d每日液体平衡量、前72 h液体平衡量及前3 d每日尿量与28 d死亡风险均无显著相关性(均P>0.05)。Kaplan-Meier生存曲线方法分析结果显示,第1个24 h、第2个24 h、第3个24 h和前72 h液体超负荷患者和非液体超负荷患者28 d生存率差异均无统计学意义(Log-rank P=0.494、0.148、0.060、0.055)。结论 AKI患者在ICU前3 d每日液体平衡量与28 d死亡风险无相关性,患者液体超负荷对28 d生存率无明显影响。

Objective To explore the effect of fluid overload on outcomes in patients with acute kidney injury(AKI). Methods Patients with AKI were enrolled in Intensive Care Unit(ICU), Shenzhen Second People′s Hospital, Guangdong Province from May 1, 2016 to January 30, 2018. They were divided into survival group and death group according to the survival condition, followed-up to 28 d. Daily fluid balance at the first 3 d of ICU stay was consecutively recorded. The baseline data were compared between the two groups. Cox regression method was used to analyze the risk factors for 28-day mortality. Kaplan-Meier method was used to analyze the influence of fluid overload on 28-day survival rate. Results Totally 133 patients diagnosed with AKI in ICU were enrolled. According to the follow-up 28-day survival condition, patients were divided into survival group(87 cases) and death group(46 cases), the 28-day mortality as 34.6%(46/133). Cox regression analysis showed that the risk for 28-day mortality increased by 10.4%(P<0.001) with every 1 point increase of Acute Physiology and Chronic Health Evaluation System Ⅱ score in patients. Male, vancomycin use, kidney replacement therapy during hospitalization, vasopressor use on ICU admission and during hospitalization also increased the risk for 28-day mortality in patients(all P<0.05). Daily fluid balance at the first 3 d of ICU stay, fluid balance at the first 72 h and daily urine output at the first 3 d were not significantly associated with the risk for 28-day mortality(all P>0.05). The Kaplan-Meier survival curve analysis showed no statistically significant differernce in 28-day survival rate between the fluid overload and the non-fluid overload at the first, second, third 24 h and the first 72 h(Log-rank P=0.494, 0.148, 0.060, 0.055). Conclusion Daily fluid balance at the first 3 d of ICU stay is not associated with the risk for 28-day mortality in patients with AKI, and fluid overload has no obvious effect on 28-day survival rate.