无症状高尿酸血症和粘菌素诱导的呼吸机相关性肺炎危重患者急性肾损伤的风险

IF 1 Q4 RHEUMATOLOGY
Alia H. Abd El Fatah, Mohamed M.Y. Khaled, Mohammed S. Sayed, Mohamed A. Fakher, Sherif R.A. Mohamed
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引用次数: 0

摘要

背景:高尿酸血症与许多慢性代谢性疾病有关,如心血管疾病、慢性肾病和代谢综合征。研究目的:揭示未发现高尿酸血症的多药和广泛耐药呼吸机相关性肺炎危重患者在使用粘菌素治疗期间发生高尿酸血症的风险及其与急性肾损伤(AKI)发展的关系。患者和方法本研究纳入重症监护病房(ICU)收治的60例呼吸机相关性肺炎患者:23例高尿酸血症,37例血清尿酸(SUA)水平正常。对APACHE II(急性生理和慢性健康评估)和顺序器官衰竭评估(SOFA)进行评分。所有患者均静脉注射粘菌素2.5 ~ 5mg /kg/d,分2 ~ 4次给药。结果患者平均年龄为61.3±14.4岁,女性17例(F∶M∶2.19),高尿酸血症患者的APACHEⅱ和SOFA(20.5±6.3和16.0±4.9)低于SUA正常患者(24.8±9.3和8.7±5.6);P = 0.0.04和P = 0.001)。高尿酸血症组有12例(52.1%)发生AKI, 11例(47.8%)死亡,SUA正常组有5例(13.5%)发生AKI, 17例(45.9%)死亡(p = 0.001和p = 0.89)。SUA水平预测AKI的曲线下面积(AUC)为0.77 (95% CI: 0.62-0.9);7 mg/dL(敏感性71%,特异性77%)(p = 0.001)。结论无症状高尿酸血症是多药耐药呼吸机相关性肺炎危重患者AKI的潜在危险因素。它可能在脓毒症相关AKI的发展中发挥作用,管理高尿酸血症可能是预防其发展的有效策略。
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Asymptomatic hyperuricemia and the risk of colistin-induced acute kidney injury in critically-ill patients with ventilator-associated pneumonia

Background

Hyperuricemia has been associated with many chronic metabolic diseases, such as cardiovascular disease, chronic kidney disease, and metabolic syndrome.

Aim of the work

To reveal the risk of hyperuricemia and its association with development of acute kidney injury (AKI) during treatment with colistin incritically-illpatients with multidrug and extensive drug resistant ventilator-associated pneumonia not known to be hyperuricemic.

Patients and methods

This study included 60 patients with ventilator-associated pneumonia admitted to the intensive care unit (ICU): 23 with hyperuricemia and 37with normal serum uric acid (SUA) levels. The APACHE II (Acute Physiology And Chronic Health Evaluation) and Sequential Organ Failure Assessment (SOFA) were scored. All patients were receiving intravenous colistin 2.5–5 mg/kg/d in 2–4 divided doses.

Results

The mean age of the patients was 61.3 ± 14.4 years, 17 females (F:M 1:2.19), the APACHE II and SOFA were lower in those with hyperuricemia (20.5 ± 6.3 and 16.0 ± 4.9) compared to those with normal SUA (24.8 ± 9.3 and 8.7 ± 5.6; p = 0.0.04 and p = 0.001). 12 (52.1 %) patients with hyperuricemia developed AKI and 11 (47.8 %) died while 5 (13.5 %) developed AKI and 17 (45.9 %) died in those with normal SUA (p = 0.001 and p = 0.89 respectively). The area under the curve (AUC) for SUA levels predicting AKI was 0.77 (95 %CI:0.62–0.9) at > 7 mg/dL (sensitivity 71 %, specificity 77 %) (p = 0.001).

Conclusion

Asymptomatic hyperuricemia is a potential risk factor for AKI in critically-ill patients with multidrug resistant ventilator-associated pneumonia. It may play a role in the development of sepsis-related AKI, and managing hyperuricemia could potentially serve as an effective strategy to prevent its development.
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来源期刊
Egyptian Rheumatologist
Egyptian Rheumatologist RHEUMATOLOGY-
CiteScore
2.00
自引率
22.20%
发文量
77
审稿时长
39 weeks
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