医学
急性肾损伤
血压
充氧
优势比
心脏病学
内科学
复苏
人口
自然循环恢复
麻醉
肾脏疾病
心肺复苏术
环境卫生
作者
Sebastian Roed Rasmussen,Karoline Korsholm Jeppesen,Jesper Kjærgaard,Christian Hassager,Henrik Schmidt,Simon Mølstrøm,Rasmus Paulin Beske,Johannes Grand,Hanne Berg Ravn,Matilde Winther‐Jensen,Mechthild Meyer,Jacob Eifer Møller
出处
期刊:Circulation
[Ovid Technologies (Wolters Kluwer)]
日期:2023-10-04
卷期号:148 (23): 1860-1869
被引量:5
标识
DOI:10.1161/circulationaha.123.066012
摘要
BACKGROUND: Acute kidney injury (AKI) represents a common and serious complication to out-of-hospital cardiac arrest. The importance of post-resuscitation care targets for blood pressure and oxygenation for the development of AKI is unknown. METHODS: This is a substudy of a randomized 2-by-2 factorial trial, in which 789 comatose adult patients who had out-of-hospital cardiac arrest with presumed cardiac cause and sustained return of spontaneous circulation were randomly assigned to a target mean arterial blood pressure of either 63 or 77 mm Hg. Patients were simultaneously randomly assigned to either a restrictive oxygen target of a partial pressure of arterial oxygen (Pa o 2 ) of 9 to 10 kPa or a liberal oxygenation target of a Pa o 2 of 13 to 14 kPa. The primary outcome for this study was AKI according to KDIGO (Kidney Disease: Improving Global Outcomes) classification in patients surviving at least 48 hours (N=759). Adjusted logistic regression was performed for patients allocated to high blood pressure and liberal oxygen target as reference. RESULTS: The main population characteristics at admission were: age, 64 (54–73) years; 80% male; 90% shockable rhythm; and time to return of spontaneous circulation, 18 (12–26) minutes. Patients allocated to a low blood pressure and liberal oxygen target had an increased risk of developing AKI compared with patients with high blood pressure and liberal oxygen target (84/193 [44%] versus 56/187 [30%]; adjusted odds ratio, 1.87 [95% CI, 1.21–2.89]). Multinomial logistic regression revealed that the increased risk of AKI was only related to mild-stage AKI (KDIGO stage 1). There was no difference in risk of AKI in the other groups. Plasma creatinine remained high during hospitalization in the low blood pressure and liberal oxygen target group but did not differ between groups at 6- and 12-month follow-up. CONCLUSIONS: In comatose patients who had been resuscitated after out-of-hospital cardiac arrest, patients allocated to a combination of a low mean arterial blood pressure and a liberal oxygen target had a significantly increased risk of mild-stage AKI. No difference was found in terms of more severe AKI stages or other kidney-related adverse outcomes, and creatinine had normalized at 1 year after discharge. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03141099.
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