{"title":"右美托咪定与脓毒症患者急性肾损伤:一项回顾性队列研究。","authors":"Papawadee Chaengsuthiworawat, Tharin Thampongsa, Thanyalak Thamjamrassri, Chawika Pisitsak","doi":"10.1007/s12630-025-02977-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Acute kidney injury (AKI) is a common complication of sepsis. AKI is associated with increased morbidity and mortality. Studies show that dexmedetomidine has a protective effect against AKI. We sought to evaluate the association between dexmedetomidine administration and AKI in patients with sepsis.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 331 adult patients with sepsis. We divided patients into two groups: patients who received an infusion of dexmedetomidine of ≥ 0.2 µg·kg<sup>-1</sup>·hr<sup>-1</sup> for > 6 hr within 72 hr of sepsis diagnosis (the dexmedetomidine group; N = 73) and patients who did not receive a dexmedetomidine infusion (the nondexmedetomidine group; N = 258). The primary outcome was the incidence of AKI within seven days, defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We analyzed our results using multivariable logistic regression models including 1) the entire cohort (331 patients) or 2) a 1:1 propensity-score-matched cohort (73 patients per group).</p><p><strong>Results: </strong>Acute kidney injury was diagnosed in 190/331 (57.4%) patients. The incidence of AKI was not different between the dexmedetomidine group and the nondexmedetomidine group in both the entire cohort (54.8% vs 58.1%; P = 0.61) and the propensity-matched cohort (54.7% vs 63.0%; P = 0.31). Additionally, there were no significant differences between groups in the incidence of renal replacement therapy (10.9% vs 13.6%; P = 0.61) and 30-day mortality (32.8% vs 24.6%; P = 0.27). We observed a statistically significant interaction between patient age > 65 yr and reduced odds of developing AKI in patients who received dexmedetomidine (adjusted odds ratio, 0.25; 95% confidence interval, 0.07 to 0.90; P = 0.03).</p><p><strong>Conclusions: </strong>While there was no association between dexmedetomidine administration and AKI in our overall cohort of patients with sepsis, we observed reduced odds of developing AKI in older patients (aged > 65 yr) who received dexmedetomidine. Further research is needed to confirm that dexmedetomidine has a protective effect against AKI in this patient population.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"966-974"},"PeriodicalIF":3.3000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228650/pdf/","citationCount":"0","resultStr":"{\"title\":\"Dexmedetomidine and acute kidney injury in patients with sepsis: a retrospective cohort study.\",\"authors\":\"Papawadee Chaengsuthiworawat, Tharin Thampongsa, Thanyalak Thamjamrassri, Chawika Pisitsak\",\"doi\":\"10.1007/s12630-025-02977-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Acute kidney injury (AKI) is a common complication of sepsis. AKI is associated with increased morbidity and mortality. Studies show that dexmedetomidine has a protective effect against AKI. We sought to evaluate the association between dexmedetomidine administration and AKI in patients with sepsis.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 331 adult patients with sepsis. We divided patients into two groups: patients who received an infusion of dexmedetomidine of ≥ 0.2 µg·kg<sup>-1</sup>·hr<sup>-1</sup> for > 6 hr within 72 hr of sepsis diagnosis (the dexmedetomidine group; N = 73) and patients who did not receive a dexmedetomidine infusion (the nondexmedetomidine group; N = 258). The primary outcome was the incidence of AKI within seven days, defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We analyzed our results using multivariable logistic regression models including 1) the entire cohort (331 patients) or 2) a 1:1 propensity-score-matched cohort (73 patients per group).</p><p><strong>Results: </strong>Acute kidney injury was diagnosed in 190/331 (57.4%) patients. The incidence of AKI was not different between the dexmedetomidine group and the nondexmedetomidine group in both the entire cohort (54.8% vs 58.1%; P = 0.61) and the propensity-matched cohort (54.7% vs 63.0%; P = 0.31). Additionally, there were no significant differences between groups in the incidence of renal replacement therapy (10.9% vs 13.6%; P = 0.61) and 30-day mortality (32.8% vs 24.6%; P = 0.27). We observed a statistically significant interaction between patient age > 65 yr and reduced odds of developing AKI in patients who received dexmedetomidine (adjusted odds ratio, 0.25; 95% confidence interval, 0.07 to 0.90; P = 0.03).</p><p><strong>Conclusions: </strong>While there was no association between dexmedetomidine administration and AKI in our overall cohort of patients with sepsis, we observed reduced odds of developing AKI in older patients (aged > 65 yr) who received dexmedetomidine. 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引用次数: 0
摘要
目的:急性肾损伤(AKI)是脓毒症的常见并发症。AKI与发病率和死亡率增加有关。研究表明右美托咪定对AKI有保护作用。我们试图评估右美托咪定给药与脓毒症患者AKI之间的关系。方法:我们对331例成人脓毒症患者进行了回顾性队列研究。我们将患者分为两组:患者在脓毒症诊断后72小时内接受≥0.2µg·kg-1·hr-1的右美托咪定输注bbb6小时(右美托咪定组;N = 73)和未接受右美托咪定输注的患者(非右美托咪定组;n = 258)。主要终点是7天内AKI的发生率,由肾脏疾病改善总体结局(KDIGO)标准定义。我们使用多变量逻辑回归模型分析我们的结果,包括1)整个队列(331例患者)或2)1:1倾向评分匹配队列(每组73例患者)。结果:331例患者中有190例(57.4%)诊断为急性肾损伤。在整个队列中,右美托咪定组和非右美托咪定组的AKI发生率均无差异(54.8% vs 58.1%;P = 0.61)和倾向匹配队列(54.7% vs 63.0%;p = 0.31)。此外,两组间肾脏替代治疗的发生率无显著差异(10.9% vs 13.6%;P = 0.61)和30天死亡率(32.8% vs 24.6%;p = 0.27)。我们观察到,在接受右美托咪定治疗的患者中,年龄0 ~ 65岁的患者与发生AKI的几率降低之间存在统计学上显著的相互作用(校正优势比,0.25;95%置信区间为0.07 ~ 0.90;p = 0.03)。结论:虽然在我们的脓毒症患者总体队列中,右美托咪定给药与AKI之间没有关联,但我们观察到接受右美托咪定治疗的老年患者(年龄在50 - 65岁)发生AKI的几率降低。需要进一步的研究来证实右美托咪定在该患者群体中对AKI具有保护作用。
Dexmedetomidine and acute kidney injury in patients with sepsis: a retrospective cohort study.
Purpose: Acute kidney injury (AKI) is a common complication of sepsis. AKI is associated with increased morbidity and mortality. Studies show that dexmedetomidine has a protective effect against AKI. We sought to evaluate the association between dexmedetomidine administration and AKI in patients with sepsis.
Methods: We conducted a retrospective cohort study of 331 adult patients with sepsis. We divided patients into two groups: patients who received an infusion of dexmedetomidine of ≥ 0.2 µg·kg-1·hr-1 for > 6 hr within 72 hr of sepsis diagnosis (the dexmedetomidine group; N = 73) and patients who did not receive a dexmedetomidine infusion (the nondexmedetomidine group; N = 258). The primary outcome was the incidence of AKI within seven days, defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We analyzed our results using multivariable logistic regression models including 1) the entire cohort (331 patients) or 2) a 1:1 propensity-score-matched cohort (73 patients per group).
Results: Acute kidney injury was diagnosed in 190/331 (57.4%) patients. The incidence of AKI was not different between the dexmedetomidine group and the nondexmedetomidine group in both the entire cohort (54.8% vs 58.1%; P = 0.61) and the propensity-matched cohort (54.7% vs 63.0%; P = 0.31). Additionally, there were no significant differences between groups in the incidence of renal replacement therapy (10.9% vs 13.6%; P = 0.61) and 30-day mortality (32.8% vs 24.6%; P = 0.27). We observed a statistically significant interaction between patient age > 65 yr and reduced odds of developing AKI in patients who received dexmedetomidine (adjusted odds ratio, 0.25; 95% confidence interval, 0.07 to 0.90; P = 0.03).
Conclusions: While there was no association between dexmedetomidine administration and AKI in our overall cohort of patients with sepsis, we observed reduced odds of developing AKI in older patients (aged > 65 yr) who received dexmedetomidine. Further research is needed to confirm that dexmedetomidine has a protective effect against AKI in this patient population.
期刊介绍:
The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’
Society and is published by Springer Science + Business Media, LLM (New York). From the
first year of publication in 1954, the international exposure of the Journal has broadened
considerably, with articles now received from over 50 countries. The Journal is published
monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article
types consist of invited editorials, reports of original investigations (clinical and basic sciences
articles), case reports/case series, review articles, systematic reviews, accredited continuing
professional development (CPD) modules, and Letters to the Editor. The editorial content,
according to the mission statement, spans the fields of anesthesia, acute and chronic pain,
perioperative medicine and critical care. In addition, the Journal publishes practice guidelines
and standards articles relevant to clinicians. Articles are published either in English or in French,
according to the language of submission.