摘要: |
目的 探讨超声造影预测脓毒症患者发生急性肾损伤及其预后的临床价值。方法 连续纳入2021年8月至2022年4月本院重症医学科的脓毒症患者进行前瞻性观察性研究。主要结局是发生AKI,次要结局是持续性AKI以及死亡。收集患者一般资料和肾功能指标。分别于入院24h内(Day 1)以及第3天(Day 3)对患者行超声造影检查,并获取定量参数包括峰值强度(PI)、达峰时间(TTP)、曲线下面积(AUC)。比较不同结局定量参数差异,用单因素logistic回归分析预测AKI及预后的影响因素,用受试者工作曲线分析其预测价值。结果 最终纳入51例脓毒症患者,共27例(52.94%)发生AKI,其中8例(29.63%)发展为持续性AKI,5例(18.52%)28d死亡。与非AKI组比较,AKI组AUC、PI减少,TTP增加,差异均有统计学意义(p<0.05)。与AKI持续组相比,AKI恢复组Day1时AUC、PI、TTP差异均无统计学意义(p>0.05),Day3时AUC、PI增加,TTP减少,差异均有统计学意义(p<0.05)。对于AKI持续组,Day1与Day3相比AUC、PI、TTP差异均无统计学意义(p>0.05)。对于AKI恢复组,与Day1相比,Day3的AUC、PI增加,TTP减少,差异均有统计学意义(p<0.05)。存活组与死亡组之间以及不同天数之间差异均无统计学意义(p>0.05)。单因素logistic回归分析显示AUC(0R,0.880)、PI(OR,0.886)、TTP值(OR,1.076)是预测AKI发生的影响因素。ROC曲线分析显示,PI、TTP、AUC预测脓毒症AKI的ROC曲线下面积分别为0.70、0.70、0.74(均p<0.05)。结论 超声造影评估的肾灌注能够预测脓毒症患者急性肾损伤的发生,且与患者预后相关。 |
关键词: 超声造影 脓毒症 急性肾损伤 肾灌注 预后 |
DOI: |
投稿时间:2023-04-04修订日期:2023-04-22 |
基金项目: |
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Contrast-enhanced ultrasound predicts acute kidney injury and its prognosis in patients with sepsis |
yufen,liuna,jiangguijun,zhongzhentong,zhanliying,zhouqing |
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Abstract: |
【Abstract】Objective To investigate the clinical value of contrast-enhanced ultrasound (CEUS) in predicting the occurrence and prognosis of acute kidney injury in patients with sepsis. Methods The prospective observational study enrolled patients with sepsis admitted to the intensive care unit of our hospital from August 2021 to April 2022. The primary outcome was the development of AKI, and the secondary outcomes were persistent AKI and death. The general information and renal function indexes of the patients were collected. The patient was examined by CEUS within 24 hours after admission (Day 1) and on Day 3 (Day 3), and quantitative parameters including peak intensity (PI), time to peak (TTP), and area under the curve (AUC) were obtained. The quantitative parameters of different outcomes were compared. Univariate logistic regression was used to analyze the influencing factors of AKI and its prognosis. The receiver operating characteristic (ROC) curve was used to analyze the value of CEUS in predicting AKI. Results A total of 51 patients with sepsis were enrolled in this study. AKI occurred in 27 patients (52.94%), of which 8 patients (29.63%) developed persistent AKI, and 5 patients (18.52%) died within 28 days. Compared with the non-AKI group, AUC and PI in the AKI group were decreased, and TTP was increased, and the differences were statistically significant (p < 0.05). Compared with AKI continuous group, there was no significant difference in AUC, PI and TTP on Day1 in AKI recovery group (p > 0.05), AUC and PI increased and TTP decreased on Day3, and the differences were statistically significant (p < 0.05). For persistent AKI group, there was no significant difference in AUC, PI and TTP between Day1 and Day3 (p > 0.05). For the AKI recovery group, compared with Day1, the AUC and PI of Day3 were increased, and TTP was decreased, and the differences were statistically significant (p < 0.05). There was no significant difference between the survival group and the death group and among different days (p > 0.05). Univariate logistic regression analysis showed that AUC (0R, 0.880), PI (OR, 0.886) and TTP (OR, 1.076) were the influencing factors for predicting AKI. ROC curve analysis showed that the area under the ROC curve of PI, TTP and AUC for predicting sepsis AKI was 0.70, 0.70 and 0.74, respectively (all p < 0.05). Conclusion Renal perfusion assessed by CEUS can predict the occurrence of acute kidney injury in patients with sepsis, and is related to the prognosis of patients. |
Key words: contrast-enhanced ultrasound Sepsis Acute kidney injury Renal perfusion prognosis |