Chest:危重病患者急性肾脏损伤与造影剂有关吗?

2019-11-02 xing.T MedSci原创

由此可见,在肾功能正常的重症成人中,低渗透压造影剂并未实质性地增加AKI。预防AKI的努力应集中在败血症、糖尿病并发症、高APACHE评分或有肾脏疾病病易感的患者上,而不是限制在ICU患者中使用造影剂。

尽管有证据表明低渗透压造影剂与急性肾损伤无关,但在肾功能正常的危重患者中评估这种关系很重要。

近日,呼吸领域权威杂志chest上发表了一篇研究文章,在这项回顾性观察性研究中,研究对象为7333名成年ICU患者。研究人员将接受造影剂的患者与根据基线特征、入院诊断、合并症和疾病严重性得出的倾向评分(PS)匹配的未暴露对照者进行比较。根据KDIGO指南通过血清肌酐来确定AKI的初始发作(第1阶段)或严重程度。

基于从2557例接受静脉造影剂的病例和4776例未暴露对照者获得的2306对PS匹配对,AKI的增加归因于造影剂为1.3%(19.3 vs. 18.0%,p=0.273),并且造影剂与疾病发作和恢复方式之间没有关联。AKI患者随后的医院死亡率增加了14.3%(18.0 vs. 3.6,p<0.001),但与AKI稳定的患者相比,进行分层比较时,其风险比没有变化。多变量回归分析将败血症、代谢紊乱、糖尿病、肾病史和疾病严重程度确定为与AKI更密切相关的因素。

由此可见,在肾功能正常的重症成人中,低渗透压造影剂并未实质性地增加AKI。预防AKI的努力应集中在败血症、糖尿病并发症、高APACHE评分或有肾脏疾病病易感的患者上,而不是限制在ICU患者中使用造影剂。 

原始出处:

Lisa-Mae S. Williams,et al.Association of contrast and acute kidney injury in the critically ill: A propensity matched study.chest.2019.https://doi.org/10.1016/j.chest.2019.10.005

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    2020-08-03 Smile2680
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    2019-11-04 sodoo

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