Crit Care Med:肾素对低血压危重症患者住院死亡率的预测优于乳酸!

2021-07-01 Nebula MedSci原创

血浆肾素动力学在预测低血压危重患者的死亡率方面可能优于乳酸动力学

全血乳酸浓度广泛用于休克状态下的灌注评估。本研究旨在确定血浆肾素浓度随时间的变化是否优于乳酸浓度的变化,以预测使用血管加压药的低血压患者的院内死亡率。

这是一项在ICU开展的前瞻性的观察性队列研究,纳入了在2020年1月期间采用血管加压药治疗持续超过6小时以保持平均动脉压在65 mmHg及以上的成年患者。

检测患者入组时和入组后 24、48和72小时的血浆肾素浓度。根据正常护理标准进行全血乳酸测量。采用逻辑回归分析评估肾素或乳酸浓度的变化是否可以预测院内死亡率。使用广义估计方程分析肾素和乳酸浓度与院内死亡率之间的相关性。

幸存者和非幸存者各时间点的肾素和乳酸浓度

总体上,从53位患者中采集了197份肾素样本和148份乳酸样本肾素浓度的自然对数 (ln) 的斜率与患者的死亡率独立相关(校正优势比[aOR] 10.35; 95% CI, 1.40–76.34; p=0.022),但乳酸浓度的(In-乳酸)无此相关性(aOR 4.78; 95% CI, 0.03–772.64; p=0.55)。广义估计方程模型显示,ln-肾素(aOR 1.18; 95% CI, 1.02–1.37; p=0.025)和In-乳酸(2.38; 95% CI, 1.05–5.37; p=0.037)均与死亡率相关。

接受者操作特征曲线下面积分析表明,初始肾素浓度可以预测院内死亡率(曲线下面积 0.682; 95% CI, 0.503–0.836; p=0.05),但初始乳酸浓度无此作用(曲线下面积 0.615; 95% CI, 0.413–0.803; p=0.27)。初始或峰值肾素和乳酸浓度之间的辨别能力没有显著差异。在每个研究时间点,与幸存者相比,非幸存者的肾素值超过正常阈值 (40 pg/mL) 的比例更高,但这种关联在乳酸中不显著。

虽然每个时间点的肾素和乳酸浓度没有显著差异,但肾素浓度的正性改变率与72小时后的院内死亡率相关,而乳酸浓度无此相关性。ln-肾素斜率每增加1个单位,患者的死亡率就增加10 倍。总之,该研究结果表明,血浆肾素动力学在预测低血压危重患者的死亡率方面可能优于乳酸动力学。

原始出处:

Jeyaraju Maniraj,McCurdy Michael T,Levine Andrea R et al. Renin Kinetics Are Superior to Lactate Kinetics for Predicting In-Hospital Mortality in Hypotensive Critically Ill Patients.[J] .Crit Care Med, 2021, https://doi.org/10.1097/CCM.0000000000005143

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    2021-07-02 景小五

    学习了

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