{"title":"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","authors":"Wataru Yajima, Shotaro Aso, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga","doi":"10.1186/s40560-025-00788-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"22"},"PeriodicalIF":3.8000,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034192/pdf/","citationCount":"0","resultStr":"{\"title\":\"Association between initial intravenous fluid volume and the composite outcome of hemodialysis dependence at discharge or in-hospital mortality in inpatients with rhabdomyolysis.\",\"authors\":\"Wataru Yajima, Shotaro Aso, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga\",\"doi\":\"10.1186/s40560-025-00788-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":16123,\"journal\":{\"name\":\"Journal of Intensive Care\",\"volume\":\"13 1\",\"pages\":\"22\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-04-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034192/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Intensive Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s40560-025-00788-w\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Intensive Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s40560-025-00788-w","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
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.
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.