Total-to-ionized calcium ratio predicts mortality in continuous renal replacement therapy with citrate anticoagulation in critically ill patients 英文参考文献.docVIP

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Total-to-ionized calcium ratio predicts mortality in continuous renal replacement therapy with citrate anticoagulation in critically ill patients 英文参考文献.doc

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Total-to-ionized calcium ratio predicts mortality in continuous renal replacement therapy with citrate anticoagulation in critically ill patients 英文参考文献

Linketal.CriticalCare2012,16:R97 /content/16/3/R97 RESEARCH OpenAccess Total-to-ionizedcalciumratiopredictsmortalityin continuousrenalreplacementtherapywith citrateanticoagulationincriticallyillpatients AndreasLink1*?,MatthiasKlingele2?,TimoSpeer2,RanjaRbah1,JanineP?ss1,AnneLerner-Gr?ber2,DaniloFliser2 andMichaelB?hm1 Abstract Introduction:Regionalcitrateanticoagulationissafe,feasibleandincreasinglyusedincriticallyillpatientson continuousrenalreplacementtherapy(CRRT).However,inpatientswithhepaticormulti-organdysfunction,citrate accumulationmayleadtoanimbalanceofcalciumhomeostasis.Thestudyaimedatevaluatingtheincidenceand prognosticrelevanceofanincreasedtotaltoionizedcalciumratio(T/ICa2+ ratio)anditsassociationtohepatic dysfunction. Methods:Weperformedaprospectiveobservationalstudyonn=208criticallyillpatientswithacutekidneyinjury (AKI)andnecessityforCRRTwithregionalcitrateanticoagulation(CRRT-citrate)betweenSeptember2009and September2011.CriticalillnesswasestimatedbySimplifiedAcutePhysiologyScoreII;hepaticfunctionwas measuredwithindocyaninegreenplasmadisappearancerate.Afterachievingasteadystateofcalcium homeostasispatientswereclassifiedintotertilesaccordingtotheT/ICa2+ ratio(2.0versus2.0-2.39versus≥2.4). Results:TheT/ICa2+ ratiowasdeterminedasanindependentpredictorfor28-daymortalityincriticallyillpatients withAKIonCRRT-citrateconfirmedbyreceiveroperatingcharacteristicsandmultivariateanalysis(Areaunderthe curve0.94±0.02;p0.001).AT/ICa2+ ratio≥2.4independentlypredicteda33.5-fold(p0.001)increasein28-day mortality-rate.TherewasasignificantcorrelationbetweentheT/ICa2+ ratioandthehepaticclearance(p0.001) andtheseverityofcriticalillness(p0.001).Theefficacyandsafetyofcitrateanticoagulation,determinedbyblood ureanitrogen,meanfilterpatencyandbleedingepisodes,werenotsignificantlydifferentbetweenthetertiles. Conclusions:InpatientsonCRRT-citrateT/ICa2+ ratioiscloselyrelatedtotheclinicaloutcomeandemergedasan independentpredictorof28-daymortality.Largerstudi