cy抑素c衍生的肾功能指标是危重患者死亡率和肾脏替代治疗的危险因素——SWECRIT队列分析

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2025-05-14 DOI:10.1016/j.jcrc.2025.155116

Erik Linné , Anna Åkesson , Maria Lengquist , Hans Friberg , Attila Frigyesi , Anders O. Larsson , Anders Grubb , Peter Bentzer

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引用次数: 0

摘要

目的评估脓毒症和非脓毒症重症监护病房（ICU）患者胱抑素c衍生的肾功能指标是否与死亡率相关。方法纳入2015年11月至2018年12月在瑞典4个icu住院24 h的成年患者数据。结果是死亡率和由于急性肾损伤而需要肾替代治疗（RRT）。采用Cox-regression对未校正的胱氨酸抑素c -估计肾小球滤过率（eGFRcys）和收缩孔综合征（SPS）与结果的相关性进行评估，并对性别、年龄、疾病严重程度、慢性肾脏疾病和肌酐进行校正分析。SPS定义为egfrys与egfr肌酐的比值0.6。结果共纳入4455例患者，其中32%为脓毒症。7.4%的队列存在SPS， 90天死亡率为30.8%。在脓毒症和非脓毒症患者中，未经调整的分析显示，SPS和eGFRcys与90天、1年死亡率和RRT相关。在一项校正分析中，SPS与脓毒症患者的1年死亡率相关（风险比[HR] 1.4, 95% CI 1.1-1.9, p = 0.021）， eGFRcys与脓毒症和非脓毒症患者的RRT相关(风险比[HR] 3.1, 95% CI 1.6-6.0, p <；0.001, egfrys≤20 vs≥60 ml/min/1.73m2)。在校正分析中未发现egfrys、SPS和死亡率之间的其他关联。我们发现SPS与脓毒症患者死亡率的相关性比非脓毒症患者更强，这表明SPS与死亡率之间的关联可能取决于潜在的病理生理。在脓毒症和非脓毒症中，基于胱抑素c的GFR估计与RRT独立相关。

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Cystatin C-derived measures of renal function as risk factors for mortality and renal replacement therapy in the critically ill – An analysis of the SWECRIT cohort

Purpose

Assess if cystatin C-derived measures of kidney function are associated with mortality in septic- and non-septic intensive care unit (ICU) patients.

Methods

Data from adult patients staying >24 h in four ICUs in Sweden from November 2015–December 2018 included. Outcomes were mortality and need for renal replacement therapy (RRT) due to acute kidney injury. Associations between cystatin C-estimated glomerular filtration rate (eGFRcys) and shrunken pore syndrome (SPS) and outcomes were assessed with Cox-regression in unadjusted and analyses adjusted for sex, age, illness severity, chronic kidney disease and creatinine. SPS was defined as a ratio between eGFRcys and eGFRcreatinine <0.6.

Results

In total, 4455 patients were included in the analysis, of which 32 % had sepsis. SPS was present in 7.4 % of the cohort, and 90-day mortality was 30.8 %. In sepsis- and non-sepsis patients, SPS and eGFRcys were associated with 90-day-, 1-year mortality and RRT in unadjusted analyses. In an adjusted analysis, SPS was associated with 1-year mortality in sepsis patients (hazard ratio [HR] 1.4, 95 % CI 1.1–1.9, p = 0.021), and eGFRcys was associated with RRT in both sepsis and non-sepsis patients (HR 3.1, 95 % CI 1.6–6.0, p < 0.001, eGFRcys <20 vs ≥60 ml/min/1.73m²). No other associations between eGFRcys, SPS and mortality were detected in adjusted analyses.

Conclusion

Our finding that SPS is more robustly associated with mortality in sepsis patients than in non-sepsis patients suggests that the association between SPS and mortality may depend on underlying pathophysiology. A cystatin C-based estimate of GFR is independently associated with RRT in sepsis and non-sepsis.

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.