Serum lactate/creatinine ratio and acute kidney injury in cardiac arrest patients

IF 2.5 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY
Liangen Lin , Congcong Sun , Yuequn Xie , Yuanwen Ye , Peng Zhu , Keyue Pan , Linglong Chen
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Abstract

Objectives

Serum lactate and creatinine levels upon admission in cardiac arrest (CA) patients significantly correlate with acute kidney injury (AKI) post-restoration of autonomic circulation. However, the association between serum lactate/creatinine ratio (LCR) and AKI in this population remains unclear. This study aimed to explore the relationship between LCR at admission and cardiac arrest-associated acute kidney injury (CA-AKI).

Design and methods

We conducted a secondary analysis of previously published data on CA patient resuscitation, categorizing them into tertiles based on LCR levels. Univariate and multivariate logistic regression models and subgroup analyses were employed to investigate the association between LCR and CA-AKI. Non-linear correlations were explored using restricted cubic splines, and a two-piece wise logistic proportional hazards model for both sides of the inflection point was constructed.

Results

A total of 374 patients (72.19 % male) were included, with intensive care unit mortality, in-hospital mortality, and neurologic dysfunction rates of 51.87 %, 56.95 %, and 39.57 %, respectively. The overall CA-AKI incidence was 59.09 %. Multivariate logistic proportional hazards analysis revealed a negative association between LCR and CA-AKI incidence (adjusted odds ratio [OR] 0.85, 95 % confidence intervals [CI] = 0.78–0.93, P=0.001). Triple spline restriction analysis depicted an L-shaped correlation between baseline LCR and CA-AKI incidence. Particularly, a baseline LCR<0.051 was negatively associated with CA-AKI incidence (OR 0.494, 95 % CI=0.319–0.764, P=0.002). Beyond the LCR turning point, estimated dose–response curves remained consistent with a horizontal line.

Conclusions

Baseline LCR in CA patients exhibits an L-shaped correlation with AKI incidence following restoration of autonomic circulation. The threshold for CA-AKI is 0.051. This finding suggests that LCR may aid in identifying CA patients at high risk of AKI.

心脏骤停患者的血清乳酸/肌酐比率和急性肾损伤。
目的:心脏骤停(CA)患者入院时的血清乳酸和肌酐水平与自主循环恢复后的急性肾损伤(AKI)密切相关。然而,该人群的血清乳酸/肌酐比值(LCR)与急性肾损伤之间的关系仍不清楚。本研究旨在探讨入院时乳酸/肌酐比值与心脏骤停相关急性肾损伤(CA-AKI)之间的关系:我们对之前发表的 CA 患者复苏数据进行了二次分析,根据 LCR 水平将其分为三等分。采用单变量和多变量逻辑回归模型以及亚组分析来研究 LCR 与 CA-AKI 之间的关系。使用限制性立方样条探索了非线性相关性,并构建了拐点两侧的双片式逻辑比例危险模型:共纳入 374 名患者(72.19% 为男性),重症监护室死亡率、院内死亡率和神经功能障碍发生率分别为 51.87%、56.95% 和 39.57%。CA-AKI 总发生率为 59.09%。多变量逻辑比例危险度分析显示,LCR与CA-AKI发生率呈负相关(调整后赔率比[OR] 0.85,95%置信区间[CI] = 0.78-0.93,P=0.001)。三重样条限制分析显示,基线 LCR 与 CA-AKI 发生率呈 L 型相关。尤其是基线 LCR:CA 患者的基线 LCR 与恢复自主循环后的 AKI 发生率呈 L 型相关。CA-AKI的阈值为0.051。这一发现表明,LCR 可能有助于识别 AKI 高风险 CA 患者。
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来源期刊
Clinical biochemistry
Clinical biochemistry 医学-医学实验技术
CiteScore
5.10
自引率
0.00%
发文量
151
审稿时长
25 days
期刊介绍: Clinical Biochemistry publishes articles relating to clinical chemistry, molecular biology and genetics, therapeutic drug monitoring and toxicology, laboratory immunology and laboratory medicine in general, with the focus on analytical and clinical investigation of laboratory tests in humans used for diagnosis, prognosis, treatment and therapy, and monitoring of disease.
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