[急性损伤的最新发展:定义,生物标志物,亚表型和管理]
Timo Mayerhöfer1, Fabian Perschinka1, Michael Joannidis2,3
1Gemeinsame Einrichtung für Intensiv- und Notfallmedizin, Department für Innere Medizin, Medizinische Universität Innsbruck, Innsbruck, Österreich.
Medizinische Klinik, Intensivmedizin und Notfallmedizin
|April 29, 2024
概括
亚临床急性损伤 (AKI),在符合经典标准之前通过生物标志物确定,表明结果更差. 早期风险分层和保守的管理,而不是加速脏替代疗法,对于重症患者来说是关键.
科学领域:
- 关键护理医学 关键护理医学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 生物标志物研究的研究.
背景情况:
- 急性损伤 (AKI) 在重症患者中很普遍,增加了发病率和死亡率.
- 目前的AKI定义依赖于KDIGO指南 (改善脏疾病全球结果).
- 新兴的生物标志物提供了对损伤的早期临床见解.
研究的目的:
- 引入使用生物标志物的亚临床AKI (1S阶段) 的新定义.
- 评估亚临床AKI对患者结果的影响.
- 评估风险分层和管理捆绑在预防严重AKI方面的有效性.
主要方法:
- 提出了一个新的AKI定义,包括基于生物标志物阳性的1S阶段.
- 审查了关于风险分层的PrevAKI和PrevAKI多中心试验的研究结果.
- 检查了STARRT-AKI和AKIKI2试验关于脏置换治疗时间的结果.
主要成果:
- 阶段1S (亚临床AKI) 与患者的治疗结果更差有关,无论使用哪种生物标志物.
- 使用生物标志物的风险分层和KDIGO捆绑实施降低了中度/严重的AKI率.
- 加快脏替代疗法没有显示任何益处;延迟治疗可能会造成伤害.
结论:
- 通过生物标志物的亚临床AKI检测对于识别高风险患者至关重要.
- 建议进行保守的管理,重点关注血液动力学和液体平衡.
- 需要未来的研究,可能涉及人工智能,以优化AKI治疗和结果.
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