横纹肌溶解患者出院时血液透析依赖或住院死亡率与初始静脉输液量的关系

IF 3.8 2区 医学 Q1 CRITICAL CARE MEDICINE
Wataru Yajima, Shotaro Aso, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
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引用次数: 0

摘要

背景:尽管专家建议横纹肌溶解患者静脉输液(IVF)以预防肾损伤,但由于过度IVF可能导致器官水肿,导致器官损伤,因此最佳IVF量尚不清楚。本研究旨在探讨IVF量与横纹肌溶解患者血液透析依赖或院内死亡的综合结局之间的关系。方法:我们使用日本诊断程序组合数据库,对2010年7月至2022年3月期间入住重症监护病房和三级医院的横纹肌溶解患者进行回顾性分析。我们将患者分为在入院3天内接受至少3500 mL/天试管婴儿的患者和没有接受试管婴儿的患者。这个阈值是根据以前的研究结果确定的。我们使用倾向评分重叠加权比较了两组间的综合结局,包括出院时的血液透析依赖和院内死亡。结果:我们确定了5392例符合条件的患者。其中,1677人(31.1%)接受了≥3500 mL/天的体外受精,3715人(68.9%)接受了结论:这项回顾性数据库研究发现,横纹肌溶解患者体外受精≥3500 mL/天与复合结局的降低无关,但与出院时血液透析依赖性的降低有关。最佳试管婴儿量仍然是未知的,需要进一步的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association between initial intravenous fluid volume and the composite outcome of hemodialysis dependence at discharge or in-hospital mortality in inpatients with rhabdomyolysis.

Background: Although experts recommend intravenous fluid (IVF) for patients with rhabdomyolysis to prevent renal injury, the optimal IVF volume remains unknown because excessive IVF may lead to organ edema, resulting in organ injury. This study aimed to investigate the association between IVF volume and the composite outcome of hemodialysis dependence or in-hospital death in patients with rhabdomyolysis.

Methods: We retrospectively identified patients with rhabdomyolysis admitted to intensive care units and tertiary-care hospitals from July 2010 to March 2022 using the Japanese Diagnosis Procedure Combination database. We divided the patients into those who received at least 3500 mL/day of IVF within 3 days of admission and those who did not. This threshold was defined based on the findings of previous studies. We compared the composite outcome, including hemodialysis dependence at discharge and in-hospital death, between the groups using propensity score overlap weighting.

Results: We identified 5392 eligible patients. Of those, 1677 (31.1%) received ≥ 3500 mL/day of IVF, and 3715 (68.9%) received < 3500 mL/day of IVF; the total volumes of IVF within 3 days of admission were 11,039 mL and 4054 mL, respectively. Propensity-score overlap weighting created balanced cohorts, which did not show significant difference in primary composite outcome between the groups (3.4% vs. 3.9%; risk difference [RD] - 0.4, 95% confidence interval [CI] - 1.8 to 0.9, P = 0.53). The proportion of hemodialysis dependence was lower in the IVF ≥ 3500 mL/day group than those in the < 3500 mL/day group (0.4% vs. 1.3%; RD - 0.9, 95% CI - 1.6 to - 0.2, P = 0.02).

Conclusions: This retrospective database study found that IVF ≥ 3500 mL/day for patients with rhabdomyolysis was not associated with a reduction in the composite outcome but was associated with a reduction in hemodialysis dependence at discharge. The optimal IVF volume still remains unknown, and further studies are warranted.

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来源期刊
Journal of Intensive Care
Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine
CiteScore
11.90
自引率
1.40%
发文量
51
审稿时长
15 weeks
期刊介绍: "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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