液体平衡和死亡率.ppt

Fluid Balance,Diuretic Use,and Mortality in Acute Kidney Injury,Morgan E.Grams,*Michelle M.Estrella,*Josef Coresh,*,Roy G.Brower,*and Kathleen D.Liu for the NationalHeart,Lung,and Blood Institute Acute Respiratory Distress Syndrome Network,Clin J Am Soc Nephrol 6:966973,2011.,FACTT,Background and objectives,Management of volume status in patients with acute kidney injury(AKI)is complex,and the role of diuretics is controversial.The primary objective was to elucidate the association between fluid balance,diuretic use,and short-term mortality after AKI in critically ill patients.,Optimal fluid management in acute kidney injury(AKI)is controversial.Traditionally,aggressive fluid resuscitation has been prescribed in AKI to avoid additional prerenal or hemodynamic insults during ongoing renal dysfunction More recently,however,observational studies have demonstrated an association between a positive fluid balance,renal nonrecovery,and mortality in children and adults with AKI.,Design,setting,participants,&measurements,Using data from the Fluid and Catheter Treatment Trial(FACTT),a multicenter,randomized controlled trial evaluating a conservative versus liberal fluid-management strategy in 1000 patients with acute lung injury(ALI),we evaluated the association of post-renal injury fluid balance and diuretic use with 60-day mortality in patients who developed AKI,as defined by the AKI Network criteria.,The Fluid and Catheter Treatment Trial(FACTT),was the largest and only multicenter trial of a fluid-restrictive management strategy for the treatment of acute lung injury(ALI).Although there was no demonstrated mortality benefit,the fluid-restrictive management strategy was associated with an increased number of ventilator-free days and a trend toward a reduced requirement for renal replacement therapy.,Results,306 patients developed AKI in the first 2 study days and were included in our analysis.There were 137 in the fluid-liberal arm and 169 in the fluid-conservative arm(P 0.04).Baseline characteristics were similar between groups.Post-AKI fluid balance was significantly associated with mortality in both crude and adjusted analysis.Higher post-AKI furosemide doses had a protective effect on mortality but no significant effect after adjustment for post-AKI fluid balance.There was no threshold dose of furosemide above which mortality increased,Conclusions,A positive fluid balance after AKI was strongly associated with mortality.Post-AKI diuretic therapy was associated with 60-day patient survival in FACTT patients with ALI;this effect may be mediated by fluid balance.,Thank you for you attention,Question,What kind relation could be between positive fluid balance and mortality after AKI according to this paper.In univariate analysis of the AKI population,what factors were significantly associated with 60-day mortality?Such as Older age,higher baseline APACHE III score and what?,