确定一个最佳值来定义重症患者的寡尿症:一项观察性研究
Nathan Axel Bianchi1,2, Marco Altarelli1, Céline Monard1
1Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), 46, Avenue du Bugnon, 1011, Lausanne, Switzerland.
Critical care (London, England)
|May 30, 2023
概括
目前对重症患者的寡尿症的定义可能过于保守. 较低的0.2毫升/公斤/小时超过3或6小时的门更好地识别患有90天死亡风险较高的患者.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 关键护理医学 关键护理医学
- 临床流行病学 临床流行病学
背景情况:
- 最近的观察性研究正在质疑目前定义寡尿症的共识值 (0.5毫升/千克/小时超过6小时).
- 需要建立一个更准确的值来识别重症患者的寡尿症.
研究的目的:
- 确定在重症患者中定义寡尿症的最佳值.
- 评估尿液输出值与90天死亡率之间的关系.
主要方法:
- 一项对15500名成年ICU患者 (2010-2020) 的回顾性队列研究.
- 使用训练套件 (80%) 开发多变量模型,以将不同时间窗口的最低平均尿量 (UO) 与90天死亡率相关联.
- 在单独的20%数据集上验证模型,评估歧视和校准.
主要成果:
- 模型显示出优异的区分 (AUC>85%) 和校准.
- 在最低平均UO和90天死亡率之间观察到非线性关系,转折点为0.2毫升/千克/小时 (3-6小时窗口) 和0.3毫升/千克/小时 (12-24小时窗口).
- 在6小时内<0.2毫升/千克/小时的值确定了一个较小的患者群体 (24.7%),与共识定义相比,预测死亡率更高.
结论:
- 寡尿症的共识定义 (0.5毫升/千克/小时超过6小时) 可能过于保守.
- 在3个或6个小时内,0.2毫升/千克/小时的门值得到了寡尿症定义的数据的支持.
- 这一修订后的门值更好地识别了危急病患者的死亡风险增加.
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