急性肾损伤重症患者的早期蛋白质输送：多中心分组随机对照试验的事后分析。

IF 6.3 1区医学 Q1 DERMATOLOGY

Burns & Trauma Pub Date : 2024-07-24 eCollection Date: 2024-01-01 DOI:10.1093/burnst/tkae027

Cheng Lv, Lingliang Zhou, Yufeng Zhou, Charles Chin Han Lew, Zheng-Yii Lee, M Shahnaz Hasan, Baiqiang Li, Yang Liu, Jiajia Lin, Wenjian Mao, Christian Stoppe, Arthur Raymond Hubert van Zanten, Weiqin Li, Yuxiu Liu, Lu Ke

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引用次数: 0

摘要

背景：关于急性肾损伤（AKI）重症患者的最佳早期蛋白质输送存在争议。本研究旨在评估危重病人早期蛋白质输送与 28 天死亡率之间的关系是否会受到急性肾损伤的影响：这是对一项多中心分组随机对照试验数据的事后分析，该试验招募了新入院的重症患者（n = 2772）。无慢性肾脏病且基线肾功能数据完整的参与者均被纳入本研究。主要结果为 28 天死亡率。研究采用 Cox 比例危险模型分析了早期蛋白质输送量（即入院后第 3-5 天的平均蛋白质输送量）与 28 天死亡率之间的关系，以及基线 AKI 阶段是否与这一关系相互影响：共纳入 2552 例患者，其中 567 例（22.2%）在入院时患有 AKI（111 例 I 期、87 例 II 期、369 例 III 期）。研究患者的平均早期蛋白质摄入量为 0.60 ± 0.38 克/千克/天。在整个研究队列中，蛋白质输送量每增加 0.1 克/千克/天，28 天死亡率就会降低 5%[危险比 (HR) = 0.95; 95% 置信区间 (CI) 0.92-0.98, p p = 0.028]。早期蛋白质输送量每增加 0.1 克/公斤/天，无 AKI 患者的 28 天死亡率就会降低 4%（HR = 0.96；95%CI 0.92-0.99，P = 0.011），AKI III 期患者的 28 天死亡率则会降低 9%（HR = 0.91；95%CI 0.84-0.99，P = 0.021）。然而，在 AKI I 期和 II 期患者中却观察不到这种关联：结论：在无 AKI 和 AKI III 期的重症患者中，增加早期蛋白质供给量（接近指南推荐值）与降低 28 天死亡率有关，但在 AKI I 期或 II 期患者中则没有相关性。

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Early protein delivery in critically ill patients with acute kidney injury: post hoc analysis of a multicenter cluster-randomized controlled trial.

Background: There is controversy over the optimal early protein delivery in critically ill patients with acute kidney injury (AKI). This study aims to evaluate whether the association between early protein delivery and 28-day mortality was impacted by the presence of AKI in critically ill patients.

Methods: This is a post hoc analysis of data from a multicenter cluster-randomised controlled trial enrolling newly admitted critically ill patients (n = 2772). Participants without chronic kidney disease and with complete data concerning baseline renal function were included in this study. The primary outcome was 28-day mortality. Cox proportional hazards models were used to analyze the association between early protein delivery, reflected by mean protein delivery from day 3-5 after enrollment, 28-day mortality and whether baseline AKI stages interacted with this association.

Results: Overall, 2552 patients were included, among whom 567 (22.2%) had AKI at enrollment (111 stage I, 87 stage II, 369 stage III). Mean early protein delivery was 0.60 ± 0.38 g/kg/day among the study patients. In the overall study cohort, each 0.1 g/kg/day increase in protein delivery was associated with a 5% reduction in 28-day mortality[hazard ratio (HR) = 0.95; 95% confidence interval (CI) 0.92-0.98, p < 0.001]. The association between early protein delivery and 28-day mortality significantly interacted with baseline AKI stages (adjusted interaction p = 0.028). Each 0.1 g/kg/day increase in early protein delivery was associated with a 4% reduction in 28-day mortality (HR = 0.96; 95%CI 0.92-0.99, p = 0.011) among patients without AKI and 9% (HR = 0.91; 95%CI 0.84-0.99, p = 0.021) among those with AKI stage III. However, such associations cannot be observed among patients with AKI stages I and II.

Conclusions: Increased early protein delivery (up to close to the guideline recommendation) was associated with reduced 28-day mortality in critically ill patients without AKI and with AKI stage III, but not in those with AKI stage I or II.

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来源期刊

Burns & Trauma 医学-皮肤病学

CiteScore

8.40

自引率

9.40%

发文量

186

审稿时长

6 weeks

期刊介绍： The first open access journal in the field of burns and trauma injury in the Asia-Pacific region, Burns & Trauma publishes the latest developments in basic, clinical and translational research in the field. With a special focus on prevention, clinical treatment and basic research, the journal welcomes submissions in various aspects of biomaterials, tissue engineering, stem cells, critical care, immunobiology, skin transplantation, and the prevention and regeneration of burns and trauma injuries. With an expert Editorial Board and a team of dedicated scientific editors, the journal enjoys a large readership and is supported by Southwest Hospital, which covers authors'' article processing charges.