BACKGROUND： Acute kidney injury （AKI） is associated with a high mortality. This study was undertaken to detect the factors associated with the prognosis of AKI.METHODS： We retrospectively reviewed 98 patients with...BACKGROUND： Acute kidney injury （AKI） is associated with a high mortality. This study was undertaken to detect the factors associated with the prognosis of AKI.METHODS： We retrospectively reviewed 98 patients with AKI treated from March 2008 to August 2009 at this hospital. In these patients, 60 were male and 38 female. Their age ranged from 19 to 89 years （mean 52.4±16.1 years）. The excluded patients were those who died within 24 hours after admission to ICU or those who had a history of chronic kidney disease or incomplete data. After 60 days of treatment, the patients were divided into a survival group and a death group. Clinical data including gender, age, history of chronic diseases, the worst laboratory values within 24 hours after diagnosis （values of routine blood tests, blood gas analysis, liver and renal function, levels of serum cystatin C, and blood electrolytes） were analyzed. Acute physiology, chronic health evaluation （APACHE） II scores and 60-day mortality were calculated. Univariate analysis was performed to find variables relevant to prognosis, odds ratio （OR） and 95% confidence interval （CI）. Multiple-factor analysis with logistic regression analysis was made to analyze the correlation between risk factors and mortality.RESULTS： The 60-day mortality was 34.7% （34/98）. The APACHE II score of the death group was higher than that of the survival group （17.4±4.3 vs. 14.2±4.8, P〈0.05）. The mortality of the patients with a high level of cystatin C〉1.3 mg/L was higher than that of the patients with a low level of cystatin C （〈1.3 mg/L） （50% vs. 20%, P〈0.05）. The univariate analysis indicated that organ failures≥2, oliguria, APACHE II〉15 scores, cystatin C〉1.3 mg/L, cystatin C〉1.3 mg/L＋APACHE II〉15 scores were the risk factors of AKI. Logistic regression analysis, however, showed that organ failures≥2, oliguria, cystatin C〉1.3 mg/L ＋APACHE II〉15 scores were the independent risk factors of AKI.CONCLUSION： Cystatin C〉1.3 mg/展开更多
Fluids are considered the cornerstone of therapy for many shock states, particularly states that are associated with relative or absolute hypovolemia. Fluids are also commonly used for many other purposes, such as ren...Fluids are considered the cornerstone of therapy for many shock states, particularly states that are associated with relative or absolute hypovolemia. Fluids are also commonly used for many other purposes, such as renalprotection from endogenous and exogenous substances, for the safe dilution of medications and as "maintenance" fluids. However, a large amount of evidence from the last decade has shown that fluids can have deleterious effects on several organ functions, both from excessive amounts of fluids and from their non-physiological electrolyte composition. Additionally, fluid prescription is more common in patients with systemic inflammatory response syndrome whose kidneys may have impaired mechanisms of electrolyte and free water excretion. These processes have been studied as separate entities(hypernatremia, hyperchloremic acidosis and progressive fluid accumulation) leading to worse outcomes in many clinical scenarios, including but not limited to acute kidney injury, worsening respiratory function, higher mortality and higher hospital and intensive care unit lengthof-stays. In this review, we synthesize this evidence and describe this phenomenon as fluid and electrolyte overload with potentially deleterious effects. Finally, we propose a strategy to safely use fluids and thereafter wean patients from fluids, along with other caveats to be considered when dealing with fluids in the intensive care unit.展开更多
文摘BACKGROUND： Acute kidney injury （AKI） is associated with a high mortality. This study was undertaken to detect the factors associated with the prognosis of AKI.METHODS： We retrospectively reviewed 98 patients with AKI treated from March 2008 to August 2009 at this hospital. In these patients, 60 were male and 38 female. Their age ranged from 19 to 89 years （mean 52.4±16.1 years）. The excluded patients were those who died within 24 hours after admission to ICU or those who had a history of chronic kidney disease or incomplete data. After 60 days of treatment, the patients were divided into a survival group and a death group. Clinical data including gender, age, history of chronic diseases, the worst laboratory values within 24 hours after diagnosis （values of routine blood tests, blood gas analysis, liver and renal function, levels of serum cystatin C, and blood electrolytes） were analyzed. Acute physiology, chronic health evaluation （APACHE） II scores and 60-day mortality were calculated. Univariate analysis was performed to find variables relevant to prognosis, odds ratio （OR） and 95% confidence interval （CI）. Multiple-factor analysis with logistic regression analysis was made to analyze the correlation between risk factors and mortality.RESULTS： The 60-day mortality was 34.7% （34/98）. The APACHE II score of the death group was higher than that of the survival group （17.4±4.3 vs. 14.2±4.8, P〈0.05）. The mortality of the patients with a high level of cystatin C〉1.3 mg/L was higher than that of the patients with a low level of cystatin C （〈1.3 mg/L） （50% vs. 20%, P〈0.05）. The univariate analysis indicated that organ failures≥2, oliguria, APACHE II〉15 scores, cystatin C〉1.3 mg/L, cystatin C〉1.3 mg/L＋APACHE II〉15 scores were the risk factors of AKI. Logistic regression analysis, however, showed that organ failures≥2, oliguria, cystatin C〉1.3 mg/L ＋APACHE II〉15 scores were the independent risk factors of AKI.CONCLUSION： Cystatin C〉1.3 mg/
文摘Fluids are considered the cornerstone of therapy for many shock states, particularly states that are associated with relative or absolute hypovolemia. Fluids are also commonly used for many other purposes, such as renalprotection from endogenous and exogenous substances, for the safe dilution of medications and as "maintenance" fluids. However, a large amount of evidence from the last decade has shown that fluids can have deleterious effects on several organ functions, both from excessive amounts of fluids and from their non-physiological electrolyte composition. Additionally, fluid prescription is more common in patients with systemic inflammatory response syndrome whose kidneys may have impaired mechanisms of electrolyte and free water excretion. These processes have been studied as separate entities(hypernatremia, hyperchloremic acidosis and progressive fluid accumulation) leading to worse outcomes in many clinical scenarios, including but not limited to acute kidney injury, worsening respiratory function, higher mortality and higher hospital and intensive care unit lengthof-stays. In this review, we synthesize this evidence and describe this phenomenon as fluid and electrolyte overload with potentially deleterious effects. Finally, we propose a strategy to safely use fluids and thereafter wean patients from fluids, along with other caveats to be considered when dealing with fluids in the intensive care unit.
