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Báo cáo y học: "Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients. | Macedo et al. Critical Care 2010 14 R82 http ccforum.eom content 14 3 R82 c CRITICAL CARE RESEARCH Open Access Fluid accumulation recognition and staging of acute kidney injury in critically-ill patients Etienne Macedo21 Josée Bouchard21 Sharon H Soroko 1 Glenn M Chertow2 Jonathan Himmelfarb3 T Alp Ikizler4 Emil P Paganini5 Ravindra L Mehta 1 for for the Program to Improve Care in Acute Renal Disease PICARD study Abstract Introduction Serum creatinine concentration sCr is the marker used for diagnosing and staging acute kidney injury AKI in the RIFLE and AKIN classification systems but is influenced by several factors including its volume of distribution. We evaluated the effect of fluid accumulation on sCr to estimate severity of AKI. Methods In 253 patients recruited from a prospective observational study of critically-ill patients with AKI we calculated cumulative fluid balance and computed a fluid-adjusted sCr concentration reflecting the effect of volume of distribution during the development phase of AKI. The time to reach a relative 50 increase from the reference sCr using the crude and adjusted sCr was compared. We defined late recognition to estimate severity of AKI when this time interval to reach 50 relative increase between the crude and adjusted sCr exceeded 24 hours. Results The median cumulative fluid balance increased from 2.7 liters on day 2 to 6.5 liters on day 7. The difference between adjusted and crude sCr was significantly higher at each time point and progressively increased from a median difference of 0.09 mg dL to 0.65 mg dL after six days. Sixty-four 25 patients met criteria for a late recognition to estimate severity progression of AKI. This group of patients had a lower urine output and a higher daily and cumulative fluid balance during the development phase of AKI. They were more likely to need dialysis but showed no difference in mortality compared to patients who did not meet the criteria for late recognition of severity progression.