BACKGROUND Postoperative acute kidney injury(AKI) is a complex pathological process involved intrarenal and systemic inflammation caused by renal hypoperfusion, nephrotoxic drugs and urinary obstruction. Neutrophil-to...BACKGROUND Postoperative acute kidney injury(AKI) is a complex pathological process involved intrarenal and systemic inflammation caused by renal hypoperfusion, nephrotoxic drugs and urinary obstruction. Neutrophil-to-lymphocyte ratio(NLR) is a marker of inflammation reflecting the progress of many diseases. However, whether NLR at admission can predict the occurrence of AKI after surgery in the intensive care unit(ICU) remains unknown.AIM To clarify the relationship between NLR and the occurrence of AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU.METHODS A retrospective analysis of 282 patients receiving surgical ICU care after gastrointestinal and hepatobiliary surgery in our hospital from December 2014 to December 2018 was performed.RESULTS Postoperative AKI occurred in 84 patients(29.79%) in this cohort. NLR by the multivariate analysis was an independent risk factor for occurrence of postoperative AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU. In this cohort, receiver operating characteristic curves of AKI occurrence showed that the optimal cut-off value of NLR was 8.380. NLR was found to be significantly correlated with the white blood cell count, neutrophil count, lymphocyte count, arterial lactate and dialysis(P < 0.05). Additionally, NLR value at admission was higher in AKI patients compared with the non-AKI patients and increased with the severity of AKI. Patients with NLR ≥ 8.380 exhibited significantly higher incidences of postoperative AKI and severe AKI than patients with NLR < 8.380(AKI: 38.12% vs 14.85%, P < 0.001;severe AKI: 14.36% vs 1.98%, P = 0.001).CONCLUSION NLR at admission is a predictor of AKI occurrence in patients with gastrointestinal and hepatobiliary surgery in ICU. NLR should be included in the routine assessment of AKI occurrence.展开更多
Acute kidney injury(AKI) is a common and serious complication in critically ill patients. The mortality rate remains high despite improved renal replacement techniques. A possible cause of the high mortality rate is t...Acute kidney injury(AKI) is a common and serious complication in critically ill patients. The mortality rate remains high despite improved renal replacement techniques. A possible cause of the high mortality rate is that intensive care unit patients tend to be older and more debilitated than before. Pathophysiological factors associated with AKI are also implicated in the failure of other organs, indicating that AKI is often part of a multiple organ failure syndrome. Until recently, there was a lack of consensus as to the best definition, characterization, and evaluation of acute renal failure. This lack of a standard definition has been a major impediment to progress in clinical and basic research. The introduction of the risk, injury, failure, loss, and end-stage kidney disease criteria and the modified version proposed by the Acute Kidney Injury Network have increased the conceptual understanding of AKI syndrome, and these criteria have been successfully tested in clinical studies. This article reviews current findings concerning the application of these criteria for assessing epidemiology and predicting outcome in specific homogeneous critically ill patient groups.展开更多
Background:This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).Methods:From July 1 to October 5 2021, 67 French ICUs pr...Background:This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).Methods:From July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the circuit.Results:A total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, respectively.Conclusions:Practices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.展开更多
基金the National Natura Science Foundation of ChinaNo. 81770491。
文摘BACKGROUND Postoperative acute kidney injury(AKI) is a complex pathological process involved intrarenal and systemic inflammation caused by renal hypoperfusion, nephrotoxic drugs and urinary obstruction. Neutrophil-to-lymphocyte ratio(NLR) is a marker of inflammation reflecting the progress of many diseases. However, whether NLR at admission can predict the occurrence of AKI after surgery in the intensive care unit(ICU) remains unknown.AIM To clarify the relationship between NLR and the occurrence of AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU.METHODS A retrospective analysis of 282 patients receiving surgical ICU care after gastrointestinal and hepatobiliary surgery in our hospital from December 2014 to December 2018 was performed.RESULTS Postoperative AKI occurred in 84 patients(29.79%) in this cohort. NLR by the multivariate analysis was an independent risk factor for occurrence of postoperative AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU. In this cohort, receiver operating characteristic curves of AKI occurrence showed that the optimal cut-off value of NLR was 8.380. NLR was found to be significantly correlated with the white blood cell count, neutrophil count, lymphocyte count, arterial lactate and dialysis(P < 0.05). Additionally, NLR value at admission was higher in AKI patients compared with the non-AKI patients and increased with the severity of AKI. Patients with NLR ≥ 8.380 exhibited significantly higher incidences of postoperative AKI and severe AKI than patients with NLR < 8.380(AKI: 38.12% vs 14.85%, P < 0.001;severe AKI: 14.36% vs 1.98%, P = 0.001).CONCLUSION NLR at admission is a predictor of AKI occurrence in patients with gastrointestinal and hepatobiliary surgery in ICU. NLR should be included in the routine assessment of AKI occurrence.
文摘Acute kidney injury(AKI) is a common and serious complication in critically ill patients. The mortality rate remains high despite improved renal replacement techniques. A possible cause of the high mortality rate is that intensive care unit patients tend to be older and more debilitated than before. Pathophysiological factors associated with AKI are also implicated in the failure of other organs, indicating that AKI is often part of a multiple organ failure syndrome. Until recently, there was a lack of consensus as to the best definition, characterization, and evaluation of acute renal failure. This lack of a standard definition has been a major impediment to progress in clinical and basic research. The introduction of the risk, injury, failure, loss, and end-stage kidney disease criteria and the modified version proposed by the Acute Kidney Injury Network have increased the conceptual understanding of AKI syndrome, and these criteria have been successfully tested in clinical studies. This article reviews current findings concerning the application of these criteria for assessing epidemiology and predicting outcome in specific homogeneous critically ill patient groups.
文摘Background:This study aimed to investigate renal replacement therapy (RRT) practices in a representative nationwide sample of French intensive care units (ICUs).Methods:From July 1 to October 5 2021, 67 French ICUs provided data regarding their ICU and RRT implementation. We used an online questionnaire to record general data about each participating ICU, including the type of hospital, number of beds, staff ratios, and RRT implementation. Each center then prospectively recorded RRT parameters from 5 consecutive acute kidney injury (AKI) patients, namely the indication, type of dialysis catheter used, type of catheter lock used, type of RRT (continuous or intermittent), the RRT parameters initially prescribed (dose, blood flow, and duration), and the anticoagulant agent used for the circuit.Results:A total of 303 patients from 67 ICUs were analyzed. Main indications for RRT were oligo-anuria (57.4%), metabolic acidosis (52.1%), and increased plasma urea levels (47.9%). The commonest insertion site was the right internal jugular (45.2%). In 71.0% of cases, the dialysis catheter was inserted by a resident. Ultrasound guidance was used in 97.0% and isovolumic connection in 90.1%. Citrate, unfractionated heparin, and saline were used as catheter locks in 46.9%, 24.1%, and 21.1% of cases, respectively.Conclusions:Practices in French ICUs are largely compliant with current national guidelines and international literature. The findings should be interpreted in light of the limitations inherent to this type of study.
基金This work was supported by the National Natural Science Foundation of China(81873607).
文摘目的:急性肾损伤(acute kidney injury,AKI)是脓毒症的危重症患者常见的并发症之一,可增加患者死亡、心血管事件和慢性肾功能不全的发生风险。AKI持续时间和AKI后肾功能恢复状况可影响患者的预后,但是脓毒症AKI后患者的早期恢复情况是否与预后密切相关,目前仍存在争议。早期预测AKI后肾功能恢复状态有利于制订个体化的治疗策略和预防严重并发症的发生,然而如何在临床上早期识别脓毒症AKI患者中肾功能未恢复的高危患者尚不清楚。本研究旨在探讨危重症患者脓毒症AKI后早期恢复状态与预后的关系,并早期识别肾功能未恢复的危险因素,以提高患者的生存质量。方法:回顾性分析2015年1月至2017年3月在中南大学湘雅二医院和湘雅三医院重症监护室(intensive care unit,ICU)住院且在进入ICU后48 h内发生AKI的脓毒症患者的临床资料。脓毒症的诊断根据第3版脓毒症与感染性休克定义国际共识(the Third International Consensus Definitions for Sepsis and Septic Shock,Sepsis-3),AKI的诊断和分期根据2012年改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,KDIGO)指南。根据诊断AKI后第7天的恢复状态,将脓毒症AKI患者分为完全恢复、部分恢复和未恢复3组。收集患者的基线特征,包括人口学特征、合并症、进入ICU时的临床和实验室检查资料以及进入ICU后24 h内的干预情况。研究的主要结局为90 d时死亡和慢性透析的复合结局,次要结局包括ICU停留天数、住院天数和持续性肾功能不全。使用多因素回归分析评估AKI后早期恢复状态对90 d预后的预测价值,并确定AKI后肾功能未恢复的危险因素。此外,我们进一步分别对诊断AKI后第7天仍在院的患者、无慢性肾脏病病史的患者和AKI分期为2~3期的患者进行敏感性分析。结果:在553例脓毒症AKI患者中,完全恢复组为251例(45.4%),部分恢复组为73例(13.2%),未恢复组为229例(41.4%)。与完全恢复组或部分恢复组患者相比,未恢复组患者90 d死亡(未恢复组vs部分恢复组、完全恢复组:64.2%vs 26.0%、22.7%;P<0.001)和复合结局(未恢复组vs部分恢复组、完全恢复组:65.1%vs 27.4%、22.7%;P<0.001)的发生率更高。此外,未恢复组患者与其他两组患者相比,住院时间更短,进展为持续性肾功能不全的比例更高。在校正了混杂因素后,与完全恢复组患者相比,未恢复组患者90 d死亡(HR=3.50,95%CI:2.47~4.96,P<0.001)和复合结局(OR=5.55,95%CI:3.43~8.98,P<0.001)发生的风险明显增加,而部分恢复组患者与完全恢复组比较差异无统计学意义(P>0.05)。男性、充血性心力衰竭、肺炎、呼吸频率>20次/min、贫血、高胆红素血症、需要机械通气和AKI 3期是AKI后肾功能未恢复的独立危险因素。敏感性分析结果进一步支持在特定患者亚组中AKI后肾功能未恢复仍然是90 d死亡和复合结局的独立预测因素。结论:危重症患者脓毒症AKI后早期恢复状态与预后不良密切相关,诊断AKI后7 d内肾功能未恢复是90 d死亡和复合结局的独立预测因素。男性、充血性心力衰竭、肺炎、呼吸增快、贫血、高胆红素血症、呼吸衰竭和严重AKI是AKI后肾功能未恢复的危险因素。因此,对于脓毒症AKI患者,应在早期阶段实时评估肾功能恢复状态,AKI后肾功能未恢复的患者则需要在住院期间持续评估肾功能,出院后加强随访,预防远期不良事件的发生。
