初始脏替代疗法 (RRT) 模式与重病AKI幸存者的90天出院后的RRT依赖性有关
Jay L Koyner1, Rachel H Mackey2, Jorge Echeverri3
1Section of Nephrology, University of Chicago, Chicago, IL, USA.
Journal of critical care
|March 9, 2024
概括
在急性脏损伤 (AKI) 患者中,连续脏替代疗法 (CRRT) 与间歇性血液透析 (IHD) 相比,在退院90天后,脏替代疗法 (RRT) 依赖的几率降低了30%. 这表明CRRT可能会改善长期的功能恢复.
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
- 医疗保健服务研究 医疗服务研究
背景情况:
- 急性损伤 (AKI) 在重症患者中很常见,通常需要置换疗法 (RRT).
- 连续置换疗法 (CRRT) 和间歇性血液透析 (IHD) 是重症监护室 (ICU) 中的主要RRT方式.
- RRT方式对功能恢复的长期影响,特别是RRT依赖,仍然是一个重要的临床问题.
研究的目的:
- 为了比较CRRT与IHD对RRT依赖90天后退院的实际有效性.
- 分析重症监护室 (ICU) 患者在重症监护室 (RRT) 后生存的急性损伤 (AKI) 的RRT依赖性.
主要方法:
- 从2018年1月到2021年6月,对美国医院出院数据 (Premier PINC AI医疗保健数据库 (PHD)) 的回顾性分析.
- 持续置换疗法 (CRRT) 与间歇性血液透析 (IHD) 在成年ICU患者中与AKI进行比较.
- 逆概率治疗权重 (IPTW) 用于平衡CRRT和IHD组之间的基线特征.
- RRT依赖性被定义为在90天出院后评估前的最后8天内≥2次RRT治疗.
主要成果:
- 在34804名患者中,3804人有90天的随访索赔数据,1064人接受CRRT,2740人接受IHD.
- 与IHD患者相比,CRRT患者更年轻,病情更严重 (败血症,休克,机械呼吸),但并发症较少.
- CRRT与医院出院时 (26.5%对29.8%) 和出院后90天 (4.9%对7.4%) 的较低RRT依赖性有关.
- 调整后的分析显示,在90天内,CRRT与IHD的RRT依赖率显著降低 (OR:0.68;95%CI:0.47-0.97;P=0.03).
结论:
- 连续脏替代疗法 (CRRT) 与间歇性血液透析 (IHD) 相比,在退院90天后,脏替代疗法 (RRT) 依赖的调整后几率降低了30%.
- 这些发现表明,CRRT可能与急性损伤 (AKI) 幸存者的更好的长期功能恢复有关.
- 结果在多个敏感性分析中一致,加强了研究结果的稳定性.
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