肝功能标志物作为急性损伤患者的预后因素,这些患者正在接受连续置换疗法
Takuya Nishino1, Yoshiaki Kubota2, Tetsuya Kashiwagi3
1Department of Health Care Administration, Nippon Medical School, Tokyo, Japan.
Renal failure
|May 21, 2024
概括
在接受连续脏替代疗法 (CRRT) 的患者中,总 bilirubin (T-Bil) 水平升高表明死亡风险较高. 在CRRT启动后监测T-Bil等肝功能标志物可以帮助识别高风险患者.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 肝病学 肝病学是一种肝病学.
- 关键护理医学 关键护理医学
背景情况:
- 急性损伤 (AKI) 需要持续的置换疗法 (CRRT) 是常见的危急病患者,往往是心血管疾病和败血症的次要.
- 高的住院死亡率与需要CRRT的AKI有关.
- 在CRRT患者中,AKI和肝功能障碍之间的关系尚不清楚.
研究的目的:
- 研究接受CRRT的患者肝功能标志物与死亡率之间的关联.
- 为了确定肝功能标志物是否可以预测这种患者群体的死亡率.
主要方法:
- 分析了1899名CRRT患者的多中心数据库.
- 第一个阶段:患者在CRRT开始和3天后根据总 bilirubin (T-Bil) 水平 (<1.2,1.22,≥2 mg/dL) 进行分类.
- 第二阶段:使用倾向分数匹配 (PSM) 来比较基于T-Bil截止值1.2 mg/dL在CRRT开始后的第3天的组.
主要成果:
- 在CRRT开始时的肝功能标志物 (T-Bil,AST,ALT,De Ritis比率) 并没有预后.
- 在CRRT开始后3天的T-Bil,AST和De Ritis比率是独立的预后因素.
- 在CRRT开始后的第3天,T-Bil水平≥1.2 mg/dL是90天死亡率的重要独立预测指标,即使在PSM (HR:2.41,p < 0.001) 之后.
结论:
- 在CRRT开始后的第3天,增加的总 bilirubin (T-Bil) 水平≥1.2 mg/dL可预测CRRT患者的90天死亡率.
- 在急性功能衰竭期间肝功能标志物的变化可能有助于对高风险患者进行分层.
- 这一发现凸显了在接受CRRT的AKI患者中监测肝功能的重要性.
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