Acute kidney injury (AKI) in patients with septic shock is associated with high mortality, but the appropriate timing for initiating continuous renal replacement therapy (CRRT) is controversial. We retrospectively enrolled 158 septic shock patients with AKI in the medical intensive care unit (ICU) from July 2016 to April 2018. The time from AKI onset to CRRT initiation was compared according to ICU mortality using Cox proportional hazard, receiver operating characteristic, and Kaplan-Meier survival analyses. At the time of ICU discharge, the mortality rate was 50.6% (n = 80). It took longer to initiate CRRT in non-survivors than in survivors (hazard ratio 1.009; 95% confidence interval [CI] 1.003–1.014; P = 0.002). The cut-off time from AKI onset to CRRT initiation for ICU mortality was 16.5 hours (area under the curve 0.786; 95% CI 0.716–0.856; P < 0.001). The cumulative mortality rate was significantly higher in patients in whom CRRT was initiated beyond 16.5 hours after AKI onset than in those in whom CCRT was initiated within 16.5 hours (log-rank test, P < 0.001). Several clinical situations must be considered to determine the optimal timing of CRRT initiation in these patients. Close observation and CRRT initiation within 16.5 hours after AKI onset may help improve survival.
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机译:败血性休克患者的急性肾损伤(AKI)与高死亡率相关,但开始进行持续性肾脏替代治疗(CRRT)的适当时机仍存在争议。我们回顾性研究了2016年7月至2018年4月在158例重症监护病房(ICU)中招募的158例AKI败血性休克患者。使用Cox比例风险,接受者操作特征和Kaplan,根据ICU死亡率比较了AKI发病至CRRT开始的时间。 -Meier生存分析。在ICU出院时,死亡率为50.6%(n = 80)。在非幸存者中启动CRRT花费的时间比幸存者要长(危险比1.009; 95%置信区间[CI] 1.003-1.014; P = 0.002)。 ICU死亡从AKI发作到开始CRRT的截止时间为16.5小时,(曲线下面积0.786; 95%CI为0.716-0.856; P <0.001)。在AKI发作后超过16.5小时开始CRRT的患者的累积死亡率显着高于在16.5小时以内开始CCRT的患者(对数秩检验,P <0.001)。必须考虑几种临床情况,以确定这些患者开始CRRT的最佳时机。 AKI发作后的16.5小时内进行密切观察和CRRT启动可能有助于提高生存率。
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