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IF 4.4 2区医学 Q1 PHARMACOLOGY & PHARMACY

Frontiers in Pharmacology Pub Date : 2024-10-07 eCollection Date: 2024-01-01 DOI:10.3389/fphar.2024.1467752

Mengqi Li, Yidi Ge, Jingjing Wang, Wenya Chen, Jiashuo Li, You Deng, Wen Xie

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引用次数: 0

摘要

背景：急性肾损伤（AKI）在肝硬化患者中很常见，尤其是在重症监护室（ICU）中，而且往往与预后不良有关。白蛋白常被用于血浆容量扩容，但其对 AKI（不包括肝肾综合征（HRS））肝硬化患者的疗效还存在争议。本研究旨在评估白蛋白治疗对患有肝硬化和非肝肾综合征 AKI 的 ICU 患者预后的影响：方法：使用 MIMIC-IV 2.2 数据库进行回顾性分析。主要终点是 28 天死亡率。采用逆概率治疗加权法（IPTW）平衡白蛋白组和非白蛋白组的基线特征：结果：共纳入了1623名患者，其中586人接受了白蛋白治疗。IPTW后，非白蛋白组样本量为1713例，白蛋白组样本量为1490例。给予白蛋白与更高的 48 小时 AKI 恢复率相关，但并没有改善整个队列的 28 天死亡率。进一步分析显示，使用浓度为 5% 的白蛋白与 28 天死亡率的改善有关（HR 0.68；95% CI 0.49-0.95；p = 0.025），而使用浓度为 25% 的白蛋白则无益处。在胆红素水平较高的患者中，白蛋白治疗可显著降低 28 天死亡率。然而，白蛋白治疗可能会增加某些亚组患者的 28 天死亡率，包括慢性肾病患者和基线白蛋白水平大于 3.3 g/dL 的患者：结论：虽然白蛋白疗法可改善某些病例的 28 天死亡率，但也可能会增加某些亚组患者的死亡率。在肝硬化和 AKI 重症患者中使用白蛋白时，应更多地考虑其风险和益处。

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Impact of albumin infusion on prognosis in ICU patients with cirrhosis and AKI: insights from the MIMIC-IV database.

Background: Acute kidney injury (AKI) is common in cirrhotic patients, especially in the intensive care unit (ICU), and is often associated with poor prognosis. Albumin is often used for plasma volume expansion, but its efficacy in cirrhotic patients with AKI [excluding hepatorenal syndrome (HRS)] is debated. This study aimed to assess the impact of albumin therapy on prognosis in ICU patients with cirrhosis and non-HRS AKI.

Methods: A retrospective analysis was conducted using the MIMIC-IV 2.2 database. The primary endpoint was 28-day mortality. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics between the albumin and non-albumin groups.

Results: A total of 1,623 patients were included, with 586 receiving albumin. After IPTW, the sample sizes were 1,713 in the non-albumin group and 1,490 in the albumin group. Albumin administration was associated with higher rates of AKI recovery at 48 h but did not improve 28-day mortality in the overall cohort. Further analysis revealed that using 5% albumin concentration was associated with improved 28-day mortality (HR 0.68; 95% CI 0.49-0.95; p = 0.025), whereas 25% albumin did not show benefit. In patients with high bilirubin levels, albumin treatment significantly reduced 28-day mortality. However, albumin therapy may increase 28-day mortality in certain subgroups, including patients with chronic kidney disease and baseline albumin levels >3.3 g/dL.

Conclusion: Although albumin therapy improved 28-day mortality in some cases, it may also increase mortality in certain subgroups. The use of albumin in critically ill patients with cirrhosis and AKI should be approached with greater consideration of its risks and benefits.

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来源期刊

Frontiers in Pharmacology PHARMACOLOGY & PHARMACY-

CiteScore

7.80

自引率

8.90%

发文量

5163

审稿时长

14 weeks

期刊介绍： Frontiers in Pharmacology is a leading journal in its field, publishing rigorously peer-reviewed research across disciplines, including basic and clinical pharmacology, medicinal chemistry, pharmacy and toxicology. Field Chief Editor Heike Wulff at UC Davis is supported by an outstanding Editorial Board of international researchers. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.