Mob raum mob Tom Qab CT hauv Cov Neeg Mob Kub Ceev Nrog Kab Mob Raum Hniav: Ib Qhov Kev Txheeb Xyuas Qhov Ua Tau Zoo

Hu rau: Audrey Hu Whatsapp / hp: 0086 13880143964 Email:audrey.hu@wecistanche.com

Taw qhia:

Mob hnyavraumraug mob(AKI) tom qab kev tswj hwm qhov sib txawv ntawm cov hlab ntsha rau kev suav tomography (CT) tshwm sim tsis tshua muaj, tab sis qee tus neeg mob yuav raug mob. Txoj kev tshawb no tau soj ntsuam AKI qhov tshwm sim ntawm lub chaw haujlwm xwm txheej ceev (ED) cov neeg mob uas muaj tus mob ua ntej.raum kab mob(CKD) kev xeem CT.Txoj kev:Qhov kev tshawb fawb rov qab no hauv kev kho mob sib koom ua ke suav nrog ED cov neeg mob yav dhau los kuaj pom nrog CKD theem 3-5 (kwv yees glomerular filtration rate<60 milliliters="" per="" minute="" per="" 1.73="" meters="" squared="" over="" at="" least="" three="" months),="" undergoing="" ct="" exams="" with="" or="" without="" intravenous="" contrast,="" from="" january="" 1,="" 2013–december="" 31,="" 2017.="" we="" excluded="" patients="" with="" ct="" prior="" to="" (30="" days)="" or="" following="" (14="" days)="" index="" ct="" and="" missing="" serum="" creatinine="" (scr)="" measurements.="" we="" applied="" propensity="" score="" matching,="" and="" then="" multivariable="" regression="" adjustment="" for="" post-ct="" ed="" disposition="" and="" ed="" diagnosis,="" to="" calculate="" the="" adjusted="" risk="" of="" aki.="" secondary="" patient-centered="" outcomes="" included="" 30-="" day="" mortality,="" end-stage="" renal="" disease="" (esrd)="" diagnosis,="" and="" dialysis="" initiation.="">Cov txiaj ntsig:Ntawm 103,573 tus neeg mob ED tsim nyog tau txais CT, cov qhab nia zoo sib xws tau txais 5,589 khub. Kho qhov kev pheej hmoo piv (ARR) rau AKI yog siab dua tag nrho rau qhov sib piv-txhim kho CT (1.6{{20}}}; 95 feem pua ​​​​ntawm kev ntseeg siab [CI], 1.43-1.79). Txawm li cas los xij, cov txiaj ntsig thib ob tsis tshua muaj tshwm sim: 19/5,589 tsis sib piv vs 40/5,589 tus neeg mob sib piv nrog kev pib lim ntshav tshiab ntawm 30 hnub (hloov txaus ntshai 0.3 feem pua ​​​​vs 0.7 feem pua; kho qhov kev pheej hmoo txo ​​0.4 feem pua ​​; 95 feem pua ​​​​CI, 0. feem pua ​​-0.7 feem pua ​​).Xaus:Hauv ED cov neeg mob uas muaj mob ntevraumkab mobnyob rau hauv CT, qhov sib txawv ntawm cov hlab ntsha tau cuam tshuam nrog kev hloov kho tag nrho ntawm AKI, tab sis cov txiaj ntsig ntawm cov neeg mob nyob nruab nrab yog qhov tsawg. Kev kho mob tseem ceeb ntawm kev hloov pauvraumraug mobTom qab CT tsis meej, txawm tias cov neeg mob uas muaj mob ntev heevraumkab mobzoo li muaj kev pheej hmoo siab.

Cistanche yog qhov zoo rau lub raum

Taw qhia

Kev nce kev siv suav tomography (CT) hauv Tebchaws Meskas Lub Tsev Haujlwm Saib Xyuas Kev Kub Ntxhov (ED) ua rau muaj kev tsis sib haum xeeb txog qhov sib txawv ntawm qhov mob hnyav.raumraug mob(CA-AKI) hauv kev tsom mus rau cov neeg mob ED, qhov chaw me me tuaj yeem ua rau muaj kev phom sij txawm tias tag nrho cov kev pheej hmoo tsawg dua.raumkab mob, "Kev pheej hmoo ntawm qhov sib txawv ntawm cov xov xwm tsis paub meej, thiab cov pov thawj uas twb muaj lawm yuav ua rau muaj kev pheej hmoo ntawm kev raug mob.9 Cov kev tshawb fawb thaum ntxov tau kwv yees qhov xwm txheej CA-AKI, thaum ua haujlwm tsis ntev los no ua rau tsis ntseeg qhov tshwm sim ntawm CA-AKI tag nrho.8,{{4 }} Meta-analyses txiav txim siab tias qhov sib piv ntawm cov hlab ntsha (IV) tsis cuam tshuam nrog AKI tsis tau tsom rau cov neeg mob ED lossismob ntevraum kab mob(CKD), thiab qhov twg cov neeg mob CKD suav nrog, cov ntsiab lus tsis sib xws. 13-15

Ib qho kev ntsuam xyuas meta suav nrog rau qhov kev tshawb fawb uas txhais CKD sib txawv, siv cov hauv paus ntshav creatinine [sCr] hauv 24 teev ntawm CT (muaj peev xwm xav txog AKI ntau dua li CKD) lossis ua ntejraumkab mobkuaj mob los ntawm cov ntaub ntawv kho mob.7,14,16 Chronicraumkab mobyuav tsum muaj lub hom phiaj kuaj cov cim ntawm lub raum tsis ua haujlwm tsis tu ncua ntev li peb lub hlis lossis ntau dua; yog li qhov sib npaug ntawm qhov txawv txav hauv paus sCr nrog CKD yuav ua rau misidentification.17

Vim li cas CA-AKI tuaj yeem nrhiav tsis tau? Cov kev tshawb fawb tej zaum yuav tsis muaj zog los kuaj xyuas CA-AKI; Muaj kev tsis sib haum xeeb tuaj yeem tshwm sim txawm tias muaj kev sim txo qis, nrog cov pab pawg tswj tsis sib xws uas muaj kev pheej hmoo siab dua rau AKI; Cov pab pawg rov qab nrog kev ntsuas sCr tiav yuav mob hnyav dua; AKI uas tsis tau kuaj pom tuaj yeem ua ke nrog CT, thiab cov qhab nia zoo sib xws yuav tsis hloov tag nrho rau qhov sib txawv ntawm qhov sib txawv thiab cov pab pawg tsis sib xws.18 Txawm li cas los xij, kev sib piv cov qhab nia sib piv yuav yog qhov ua tau zoo tshaj plaws los ntsuas CA-AKI, tsis tuaj yeem mus sim.19 Thaum kawg, Qhov tseem ceeb ntawm lub sij hawm luv luv AKI tsis paub meej txog cov txiaj ntsig ntawm cov neeg mob hauv qhov chaw kho mob xws li kev mob ntshav qab zib thiabraum kab mobhnyav.

Ntawm cov neeg mob uas muaj mob nruab nrab-rau- mob hnyav CKD (theem 3-5), cov ntaub ntawv txwv tsis pub tshaj tawm, tab sis cov neeg mob no yuav muaj feem cuam tshuam rau CA-AKI txawm tias tag nrho cov kev pheej hmoo tsawg.7,8,16 Ob ntawm cov Cov kev tshawb fawb loj tshaj plaws ntawm CA-AKI suav nrog cov neeg mob CKD tsawg tshaj plaws nyob rau lub sijhawm kawm ntev.7,8 Ib txoj kev tshawb fawb tsom rau cov neeg mob uas muaj CKD ua ntej tuaj yeem qhia meej txog kev sib koom ntawm IV qhov sib piv nrog AKI hauv cov neeg uas muaj feem pheej hmoo. . Peb piv qhov tshwm sim ntawm AKI nyob rau hauv ib pawg loj ntawm ED cov neeg mob uas muaj CKD ua ntej 3-5, tsis muaj qhov sib txawv lossis qhov sib txawv-hloov kho CT, los ntawm kev siv cov qhab nia zoo sib xws rau cov pab pawg kom muaj feem tau txais qhov sib txawv raws li lub xub ntiag ntawm yav dhau los tau piav qhia txog AKI kev pheej hmoo.

Txoj kev

Kawm Tsim thiab Teeb

Peb tau ua qhov kev tshawb fawb rov qab los ntawm Kaiser Permanente Northern California, qhov loj, tsis muaj txiaj ntsig kev noj qab haus huv kev sib koom ua ke saib xyuas plaub lab tus neeg mob, nrog ntau dua 1.2 lab ED mus ntsib txhua xyoo hauv 21 lub zej zog EDs. Cov neeg mob zoo ib yam li cov pej xeem hauv cheeb tsam thiab muaj kev noj qab haus huv, haiv neeg, thiab ntau haiv neeg.20 Cov kab ke kev noj qab haus huv siv ib daim ntawv kho mob hauv hluav taws xob (EHR). Kaiser Permanente Northern California Institutional Review Board tau tso cai zam kev tso cai rau cov ntaub ntawv no nkaus xwb - Health Insurance Portability thiab Accountability Act-raws li txoj kev kawm.

Txhim kho lub raum ua haujlwm: cistanche extract

Cov ntaub ntawv

Tag nrho cov ntaub ntawv tau raug rho tawm hauv hluav taws xob los ntawm EHR (Epic Systems Corporation, Verona, WI) thiab nws cov ntaub ntawv los ntawm tus kws tshaj lij programmer (JH). Cov txheej txheem hluav taws xob rho tawm siv cov txheej txheem txheej txheem tam sim no, kev faib tawm sab hauv thiab thoob ntiaj teb ntawm cov kab mob, Cuaj Hlis Hloov Kho, thiab Kaum Hloov Kho (ICD-9 thiab ICD-10) cov lej.

Kev Xaiv Tus Neeg Koom Tes

All ED visits by adult patients (>17 xyoo) nrog EHR kev kuaj mob ntawm CKD theem 3-5 uas tau txais CT lub taub hau, caj dab, hauv siab, plab, lossis lub plab hauv plab hauv ED txij Lub Ib Hlis 1, 2013- Kaum Ob Hlis 31, 2017, suav nrog.16,17,21 Ntevraum kab mobtheem 3, 4 thiab 5 yog txhais raws li kwv yees glomerular filtration rate (eGFR) nruab nrab ntawm 30-59 milliliters ib feeb ib 1.73 meters squared (mL/min/1.73m2), 15-29 mL/min/1.73m2 thiab<15 ml/min/1.73m2="" ,="" respectively,="" persisting="" over="" three="" months="" or="" longer.="" patients="" with="" end-stage="" renal="" disease="" (esrd)="" or="" dialysis="" were="" excluded="" since="" scr="" fluctuations="" can="" be="" inaccurate;="" we="" did="" include="" patients="" with="" ckd="" stage="" 5="" who="" were="" not="" on="" dialysis.="" patients="" missing="" initial="" and="" follow-up="" (24-72="" hour)="" scr="" were="" excluded.7,8,10="" we="" also="" excluded="" exams="" 30="" days="" prior="" to="" and="" 14="" days="" after="" the="" index="" ed="" visit="" to="" avoid="" confounding="" due="" to="" repeat="" contrast="" administration="" or="" residual="" contrast="" effects.="" only="" the="" first="" study-eligible="" ed="" ct="" was="" included="" to="" avoid="" sampling="" bias="" due="" to="" clustering="" by="" the="" patient;="" thus,="" no="" patients="" crossed="">

Kev Tshaj Tawm Variable

Peb hluav taws xob rho tawm IV kev tswj hwm qhov sib txawv raws li CT xaj thiab cov txheej txheem txheej txheem. Omnipaque 300 thiab 350 thiab Isovue 370 (tsis yog-ionic low-osmolar contrast media) tau siv, thiab cov txheej txheem hauv tsev tau pom zoo rau kev tswj hwm ntim ntawm 100-150 mL nrog 20-25 feem pua ​​​​ txo koob tshuaj rau eGFR< 45="" ml/min/1.73m2,="" at="" the="" discretion="" of="" local="" radiologists="" and="" emergency="" physicians.="" the="" range="" of="" contrast="" dose="" was="" 75-150="" ml,="" including="" angiogram="" (aorta="" and="" pulmonary="" angiogram)="" studies;="" given="" that="" all="" contrast="" was="" intravenously="" administered,="" these="" studies="" were="" considered="" equivalent="" for="" the="" purpose="" of="" renal="" exposure="" to="" contrast.="" although="" the="" contrast="" phase="" for="" image="" capture="" may="" be="" different="" in="" various="" studies,="" this="" difference="" should="" not="" affect="" the="" circulation="" or="" renal="" filtration="" of="" contrast.="" as="" head,="" neck,="" chest,="" abdomen,="" and="" pelvis="" cts="" obtained="" in="" the="" ed="" may="" be="" performed="" with="" or="" without="" contrast,="" these="" studies="" were="">

Peb tsis muaj peev xwm stratify los ntawm lub cev pawg, zoo ib yam li cov kev tshawb fawb ua ntej ntawm AKI tom qab qhov sib piv. Txawm li cas los xij, hauv kev sim txo qis kev xaiv tsis zoo yam tsis muaj kev txwv ntau dhau ntawm pawg, peb tsis suav nrog CTs feem ntau vim tias lawv tsis tshua ua nrog IV qhov sib txawv thiab yuav tsis muaj nyob hauv pawg sib txawv. Contrast-enhanced CT (CECT) yog ib qho kev tshawb fawb lossis kev tshawb fawb nrog IV qhov sib txawv. Kev tswj qhov ncauj qhov sib txawv tsis raug ntsuas. Kev kuaj CT sib law liag ua rau muaj qhov tsis sib xws. Peb lub koom haum tsis tswj hwm ntau qhov sib law liag IV sib sib zog nqus boluses. Ob tus kws kho mob (MVK, tshuaj kho mob xwm txheej ceev; VAA, hluav taws xob) tau tshuaj xyuas ib qho piv txwv ntawm kev txiav txim siab thiab cov ntawv ceeb toom kom siv tau qhov sib txawv ntawm hluav taws xob.

Lwm yam kev hloov pauv thiab txhais

Peb siv cov qhab nia zoo sib xws kom sib npaug rau cov yam ntxwv uas yuav cuam tshuam nrog kev tswj hwm qhov sib txawv thiab AKI hauv pawg tsis sib xws thiab qhov sib txawv. Ntau yam uas tau piav qhia yav dhau los AKI qhov kev pheej hmoo tau suav nrog hauv cov qauv kev xav, suav nrog cov hauv qab no: hnub nyoog; poj niam txiv neej; haiv neeg / haiv neeg; comorbidities; CKD theem; Cov cim qhia mob hnyav; thiab siv cov tshuaj nephrotoxic (Table 1).7, 8, 10,18, 22,23 Cov kab mob hnyav hnyav tau txhais tias yog ED systolic ntshav siab <90 millimeters="" mercury="" (mm="" hg)="" thiab="" emergency="" severity="" index="" (esi)="" qib.="" 1="" lossis="" 2="" (esi="" yog="" qhov="" ntsuas="" ntawm="" ed="" tus="" neeg="" mob="" acuity24).="" kev="" hloov="" kho="" kev="" noj="" qab="" haus="" huv="" nyob="" rau="" hauv="" kab="" mob="" raum="" sib="" npaug="" yog="" siv="" los="" xam="" egfr.25="" cov="" tshuaj="" tiv="" thaiv="" kab="" mob="" thiab="" iv="" hydration="" tau="" piav="" qhia="" txog="" kev="" siv="" tsawg="" thiab="" tsis="" paub="" meej,="" yog="" li="" tsis="" raug="">

Peb muab cov khoom siv hluav taws xob rho tawm los ntawm cov khoom siv hluav taws xob suav nrog hauv cov qauv propensity raws li kev kuaj mob, tshwj tsis yog rau hemoglobin thiab sCr, uas yog qhov ntsuas qhov ntsuas. Yog tias tus neeg mob tsis muaj EHR cov ntaub ntawv ntawm kev kuaj mob tshwj xeeb lossis tshuaj, lawv raug suav tias tsis muaj pov thawj ntawm tus mob lossis tshuaj. Cov neeg mob uas ploj lawm sCr qhov tseem ceeb tau raug cais tawm vim qhov hloov pauv no yog qhov tseem ceeb los suav cov txiaj ntsig tseem ceeb ntawm AKI. Rau hemoglobin, txawm li cas los xij, muaj qhov ntsuas tus nqi ntawm hemoglobin <11milligrams ib="" deciliter="" (mg="" dl)="" tau="" suav="" hais="" tias="" yog="" pov="" thawj="" ntawm="" ntshav="" qab="" zib.="" tsis="" muaj="" kev="" ntsuas="" lossis="" ntsuas="" ntawm="" hemoglobin=""> 11 mg / dL raug suav tias tsis muaj pov thawj ntawm ntshav ntshav.

Nyob rau hauv tus qauv los xam cov qhab nia propensity, peb suav nrog tsuas yog yam uas tuaj yeem cuam tshuam qhov sib txawv ntawm kev tswj hwm los ntawm tus kws kho mob xwm txheej ceev thiab yuav muaj nyob rau lub sijhawm ntawm CT thiab kev txiav txim sib txawv (kev kho mob). Ob qhov sib txawv tseem ceeb cuam tshuam nrog AKI uas tej zaum yuav tsis muaj nyob rau lub sijhawm ntawm qhov kev txiav txim siab sib txawv yog chav saib xyuas mob hnyav (ICU) nkag thiab lees paub kuaj mob (sepsis, mob myocardial infarction, ntau lub cev tsis ua haujlwm, ICD-9 lossis 10 tus lej). Peb tau rho tawm cov kev hloov pauv no tab sis txheeb xyuas lawv tom qab qhov kev xav tau ntawm tus qauv ua qauv.

Cov txiaj ntsig ntawm cistanche extract:Txhim kho lub raum ua haujlwm

Cov txiaj ntsig ntsuas

Peb suav cov txiaj ntsig tseem ceeb, AKI, los ntawm sCr qhov tseem ceeb raws li tau hais los ntawm AcuteLub raumKev raug mobCov txheej txheem network (sCr nce ntxiv 0.3 mg/dL lossis 1.5-fold nce ntxiv SCR), tshaj 24-72 teev tom qab CT, zoo ib yam nrog cov kev tshawb fawb ua ntej.7,10 ,27-29 Muab hais tias AKI tsis tas yuav cuam tshuam nrog kev hloov pauv mus tas li hauv lub raum ua haujlwm, peb kuj tau soj ntsuam cov txiaj ntsig ntawm tus neeg mob thib ob. Cov txiaj ntsig thib ob no (30- hnub pib lim ntshav, kuaj ESRD tshiab, thiab kev tuag) tau muab rho tawm los ntawm EHR, Social Security Administration, thiab California lub xeev cov ntaub ntawv tuag. Lub qhov rais tom qab tau luv luv los txwv qhov tsis txaus ntseeg los ntawm cov xwm txheej kho mob hauv qab ntawm qhov sib piv / CT raug. Txoj kev tshawb no tsis tau tsim tshwj xeeb los txheeb xyuas cov txiaj ntsig thib ob no.

Kev txheeb cais

Muab qhov kev txhawj xeeb thiab kev coj ncaj ncees ntawm cov kev tshawb fawb yav tom ntej uas suav nrog randomization rau qhov sib piv, peb siv cov qhab nia zoo sib xws.7,10,16,30,31 Peb suav cov qhab nia zoo los ntawm kev siv tus qauv logistic regression nrog rau cov yam ntxwv (Table 1) uas tuaj yeem cuam tshuam rau kev txiav txim siab los tswj IV qhov sib txawv (kev kho mob) thiab cuam tshuam nrog AKI.7,8,10,18,22,23 Cov pab pawg neeg sib tw ntawm pawg CECT thiab pawg CT tsis sib xws yog derived los ntawm kev siv 1: 1 ratio greedy matching ntawm propensity qhab nia, nrog ib tug caliper ntawm 0.05 tus qauv sib txawv ntawm lub propensity qhab nia logit uas tsis muaj kev hloov. Peb tau tshuaj xyuas cov qauv sib txawv thiab qhov sib txawv ntawm qhov sib txawv los txiav txim siab tias tus qauv sib tw tau sib npaug ntawm tus neeg mob tus yam ntxwv. Peb kuj tau txheeb xyuas qhov kev faib tawm ntawm qhov kwv yees qhov kev xav tau rau ob pawg rau qhov sib tshooj.

Hauv qhov piv txwv ntawm cov qhab-nees zoo sib xws, peb siv logistic regression los tshuaj xyuas kev sib raug zoo ntawm qhov sib txawv CT thiab cov txiaj ntsig tseem ceeb thiab cov txiaj ntsig thib ob tau hloov kho rau ED qhov kev xav thiab kev kuaj mob. Peb xam qhov kev pheej hmoo hloov kho rau ob pawg los ntawm kev siv cov coefficients los ntawm cov qauv sib txawv ntawm cov logistic regression mus rau pawg neeg tshawb fawb zoo li txhua tus neeg mob nyob hauv pawg CECT, thiab txhua tus neeg mob nyob hauv pab pawg tsis sib xws, raws li, thiab qhia txog kev pheej hmoo hloov kho. qhov sib txawv thiab qhov kev pheej hmoo. Cov pab pawg ntawm CKD qhov hnyav tau raug soj ntsuam zoo ib yam nrog cov qauv sib txawv ntawm cov logistic regression rau CKD theem 3 thiab CKD theem 4-5.

Txij li thaum eGFR hloov pauv ntau dua li ntawm CKD theem, peb tau ua ntau qhov kev ntsuam xyuas rhiab heev los ntsuas qhov sib txawv ntawm AKI ntawm qhov sib txawv thiab tsis sib xws raws li eGFR, qhov ntsuas hnyav dua ntawmraummuaj nuj nqi. Peb piv AKI qhov xwm txheej stratified los ntawm lub hauv paus eGFR (<30, 30-44,="" and="">44 mL/feeb (min)/1.73 m squared [m2]) nyob rau hauv thawj propensity-match cohort. Peb kuj tau rov hais dua qhov kev txheeb xyuas hauv peb qhov sib txawv ntawm cov qhab-nees sib npaug sib npaug los ntawm cov kab hauv qab eGFR strata.

Txhua qhov kev txheeb xyuas tau ua nrog SAS version 9.4 (SAS Institute, Inc., Cary, NC) thiab Stata version 14.2 (StataCorp, College Station, TX). Qhov ntsuas qhov tseem ceeb tau teev tseg ntawm P-tus nqi<>

TSEEM CEEB

Kawm Subject Yam ntxwv

Thaum lub sijhawm kawm, 103,573 tus neeg laus ED cov neeg mob nrog CKD theem 3-5 tau txais kev kawm CT. Tom qab tsis suav nrog 10,938 cov neeg mob uas ua ntej (30 hnub ua ntej) thiab 4,918 nrog rau tom ntej (14 hnub tom qab) CT, tshem tawm cov neeg mob uas ploj lawm hauv paus (11,771) thiab rov qab (49,031) SCR qhov tseem ceeb, thiab txwv tsis pub cov neeg sib koom ua ke rau thawj qhov tsim nyog tuaj ntsib ( tsis suav nrog 5,178 ntsib) hauv lub sijhawm kawm, 21,737 ntsib tseem nyob, nrog 5,980 CECT thiab 15,757 tsis sib xws CT (Daim duab). Propensity score matching yielded 5,589 khub ntawm cov neeg mob (391 cov neeg mob los ntawm pawg CECT raug tshem tawm vim tsis muaj qhov sib tw hauv pawg CT uas tsis sib xws). Cov yam ntxwv ntawm ob pawg tau sib npaug nrog tus nqi tseeb ntawm cov qauv sib txawv<0.10 and="" variance="" ratios="" between="" 0.5="" and="" 2.0.="" there="" was="" no="" evidence="" of="" a="" violation="" of="" the="" overlap="" assumption="" when="" checking="" the="" distributions="" of="" propensity="" scores="" of="" the="" two="" groups="" (appendix="">

Cov yam ntxwv ntawm cov thawj coj thiab cov neeg muaj kev sib haum xeeb tau nthuav tawm hauv Table 1, suav nrog hnub nyoog, poj niam txiv neej, haiv neeg / haiv neeg, ua ntej CT sCr (kuaj ntsuas hauv 24 teev ua ntej CT), ICD-9 lossis 10 kev kuaj mob (proteinuria , hypoalbuminemia, ib lub raum, hloov lub raum, kab mob peripheral vascular, kab mob plawv, keeb kwm ntawm myocardial infarction, ntshav qab zib, congestive plawv tsis ua hauj lwm, kub siab), anemia (laboratory ntsuas hemoglobin.<11 mg/dl)="" and="" outpatient="" prescription="" (past="" 90="" days)="" or="" ed="" use="" of="" nephrotoxic="" medications="" (diuretic,="" angiotensin-converting="" enzyme="" inhibitor,="" antimicrobial="" agents,="" nonsteroidal="" anti-inflammatories,="" others="" –="" appendix="" b).="" older="" age,="" non-white="" race,="" male="" gender,="" and="" comorbidities="" except="" peripheral="" vascular="" disease="" and="" hypoalbuminemia="" were="" significantly="" associated="" with="" non-contrast="" ct.="" all="" variables="" in="" table="" 1="" were="" included="" in="" the="" propensity="">

Peb tau txheeb xyuas 5,589 khub ntawm cov neeg mob nrog CECT thiab tsis sib xws CTs siv cov qhab nia zoo sib xws, hnub nyoog nruab nrab ntawm 80 xyoo rau qhov tsis sib xws CT (interquartile ntau 72-86 xyoo), thiab 79 xyoo rau CECT (interquartile ntau yam {{7 }} xyoo) kev xeem. Comorbidity thiab demographic yam ntxwv tau muab piv los ntawm cov pab pawg nyob rau hauv lub propensity score-match cohort (Table 1). Mob ntshav qab zib mellitus, kub siab, thiab anemia tau tshwm sim. Tom qab cov qhab nia zoo sib xws, CKD theem 4 lossis 5 tau tshwm sim hauv 3 feem pua ​​​​ntawm cov pab pawg.

Cov neeg mob nyob rau hauv pawg tsis sib xws muaj feem ntau yuav tau mus rau ICU (9 feem pua ​​​​vs 7 feem pua, 510 ntawm 5,589 cov neeg mob tsis sib xws thiab 383 ntawm 5,589 CECT cov neeg mob, raws li, P<0.001) and="" had="" a="" higher="" frequency="" of="" acute="" organ="" failure="" (65="" of="" 5,589="" vs="" 39="" of="" 5,589,="" p="0.01)," whereas="" the="" cect="" group="" had="" a="" higher="" frequency="" of="" acute="" heart="" failure="" diagnosis="" (6%="" or="" 326="" of="" 5,589="" cect="" patients="" vs="" 4%="" or="" 217="" of="" 5,589="" non-contrast="" patients,=""><0.001) (table="" 2).="" the="" frequency="" of="" acute="" myocardial="" infarction="" (2%,="" 83="" of="" 5,589="" non-contrast="" patients="" and="" 2%="" or="" 90="" of="" 5,589="" cect="" patients,="" p="0.59)" and="" sepsis="" (6%="" or="" 332="" of="" 5,589="" non-contrast="" patients="" and="" 6%="" of="" 315="" of="" 5,589="" cect="" patients,="" p="0.49)" were="" not="" different="" between="">

Cov txiaj ntsig tseem ceeb AKI tshwm sim

Tom qab cov qhab nia zoo sib xws, qhov kev hloov pauv ntawm AKI yog 8.3 feem pua ​​​​hauv cov pab pawg tsis sib xws piv rau 13.2 feem pua ​​​​rau CECT rau 5,589 khub (kho qhov kev pheej hmoo piv [ARR] rau AKI 1.60, 95 feem pua ​​​​ntawm kev ntseeg siab [CI ], 1.43-1.79) (Table 3). AKI qhov kev pheej hmoo tsis zoo yog 5 feem pua ​​​​siab dua rau CECT (95 feem pua ​​​​CI, 3.8 feem pua ​​-6.1 feem pua ​​). Qhov kev pheej hmoo siab dua ntawm AKI hauv CECT tseem tseem ceeb hauv stratum ntawm cov neeg mob CKD theem 3 (7.9 feem pua ​​​​tsis sib piv vs 12.8 feem pua ​​CECT rau 5403 khub, ARR 1.61, 95 feem pua ​​CI,1.43-1.80) tab sis tsis yog rau cov neeg mob me me ntawm CKD 4-5 (18.9 feem pua ​​​​tsis sib piv vs 26.8 feem pua ​​CECT rau 186 khub, ARR 1.41, 95 feem pua ​​​​CI, 0.96-2.08). Qhov xwm txheej tsis hloov pauv ntawm AKI muaj nyob rau hauv Cov Ntawv Ntxiv C, Table C1.

Secondary Patient-centered

Cov txiaj ntsig tau hloov kho cov kev pheej hmoo rau cov txiaj ntsig ntawm tus neeg mob thib ob hauv nruab nrab ntawm 30 hnub (kev kuaj mob tshiab ntawm ESRD, pib ntawm kev lim ntshav, thiab kev tuag) tau tshaj tawm nyob rau hauv Table 4. Kev pib tshiab ntawm lub raum lim ntshav thiab kev kuaj mob tshiab ntawm ESRD tsis tshua muaj (Appendix C, Table C2). ). Ob pawg tsis sib xws thiab CECT muaj qhov tseem ceeb ntawm 30- hnub tuag (8.5 feem pua ​​thiab 7.1 feem pua, raws li).

Kev soj ntsuam rhiab heev

Cov txiaj ntsig tau los ntawm kev soj ntsuam rhiab cais cais kev txheeb xyuas AKI qhov xwm txheej stratified los ntawm lub hauv paus ua ntej-CT eGFR nyob rau hauv lub propensity-matched cohort raws li nyob rau hauv ib tug cais propensity-matched cohort raws li eGFR strata (45-59, 30-44, thiab<30 ml/min/1.73m2="" )="" were="" consistent="" with="" the="" results="" based="" on="" ckd="" stage="" (3="" vs="" 4-5)="" (appendix="" c,="" tables="" c3="" and="">

Kev sib tham

Hauv kev tshawb fawb txog qhov sib piv CT thiab mob raum raug mob ntawm cov neeg mob ED uas muaj kab mob raum ntev hauv kev kho mob sib xyaw, peb pom tias IV qhov sib txawv-hloov kho CT tau cuam tshuam nrog kev pheej hmoo tag nrho ntawm AKI piv rau qhov tsis sib xws CT (kho qhov kev pheej hmoo sib txawv. 5 feem pua ​​, 95 feem pua ​​​​CI, 3.8 feem pua ​​-6.1 feem pua ​​; ARR 1.60, 95 feem pua ​​CI, 1.43-1.79). Cov txiaj ntsig ntawm tus neeg mob thib ob (kev tuag, kev pib lim ntshav tshiab) tsis tshua muaj, txwv kev txiav txim siab txog qhov sib txawv ntawm pawg; Txawm li cas los xij, tag nrho cov kev soj ntsuam tsawg tsawg ntawm 30 hnub qhia tias yuav tsum tau kawm ntxiv txog kev sib raug zoo ntawm AKI hauv kev teeb tsa ntawm IV-kev sib piv kev tswj hwm thiab cov txiaj ntsig ntawm kev kho mob.

Feem ntau cov kev sib txawv ntawm AKI cov kev tshawb fawb ua ntej tsis tau tsom rau cov neeg mob CKD lossis cov neeg mob xwm txheej ceev, tab sis cov ntaub ntawv tsis ntev los no hu rau kev paub ntxiv rau cov neeg mob "mob raum mob hnyav" uas cov kev tshawb fawb ua ntej tau mus txog qhov sib txawv.3,7,9,16 Meta- Kev soj ntsuam xaus tsis muaj kev sib raug zoo ntawm qhov sib txawv thiab AKI, tab sis ib qho kev tshawb fawb taw qhia txog qhov tseem ceeb ntawm kev pheej hmoo rau AKI tom qab qhov sib piv yog qhov ua ntej muaj mob raum tsis ua haujlwm, uas tsis yog kho tau zoo sib xws thoob plaws cov kev tshawb fawb.14,21,27 Kev pheej hmoo txaus ntshai yog qhov tseem ceeb hauv cov no cov neeg mob, los txiav txim siab seb puas yuav siv cov tshuaj txo qis, tsis txhob sib piv, lossis xav txog lwm txoj hauv kev rau CT. Peb tsom mus rau cov neeg mob CKD tau soj ntsuam hauv ED, qhov kev ntsuam xyuas ceev ceev yuav tsum tau tswj hwm qhov sib txawv hauv ntau qhov xwm txheej; Peb tau siv cov qhab nia zoo sib xws los txo cov kev xaiv tsis ncaj ncees hauv kev tswj hwm qhov sib txawv thiab hloov kho rau cov mob hnyav tom qab CT.

Cov me me ntawm kev sib raug zoo-ua khub nrog CKD hnyav hauv peb txoj kev kawm thiab lwm tus taw qhia rau CECT kev zam txawm tias cov ntaub ntawv qhia txog qhov tsis txaus ntseeg tag nrho CA-AKI qhov xwm txheej. Ob peb txoj kev tshawb fawb tau tsom tshwj xeeb rau cov neeg mob CKD, thiab cov txiaj ntsig sib txawv tau tshaj tawm hauv cov kev tshawb fawb loj dua, nrog cov ntsiab lus tsis sib xws ntawm lub raum tsis ua haujlwm uas tsis paub qhov txawv ntawm qhov txawv txav "pem hauv ntej" ua ntej CT eGFR etiologies - seb vim li cas los ntawm incipient AKI, ntev eGFR. yam tsis muaj AKI txuas ntxiv, lossis sib txuas AKI thiab CKD thaum lub sijhawm kawm.7,8,10,32 suav nrog cov neeg mob uas muaj AKI lossis tsis paub txog lub raum tsis ua haujlwm yuav ua rau pom tsis meej AKI.

Sib piv cov txiaj ntsig thoob plaws cov kev tshawb fawb nrog cov ntsiab lus sib txawv ntawm lub raum ua haujlwm tsis zoo kuj nyuaj. Hinson thiab al tau tshaj tawm txog 1557 tus neeg mob (12 feem pua) nrog kev kuaj mob CKD hauv kev tshawb fawb loj dua tseem yuav luag ob npaug - 3021 (23 feem pua) - tus naj npawb ntawm cov neeg mob CKD uas muaj eGFR<60 ml/min/1.73m2="" at="" the="" time="" of="" ct,="" suggesting="" a="" notable="" degree="" of="" unexplained="" renal="" dysfunction="" in="" the="" cohort,="" while="" davenport="" et="" al="" included="" 3685="" patients="" (20%)="" with=""><60 ml/min/1.73m2="" and="" excluded="" patients="" with="" undefined="" "unstable="" renal="" function."7,10="" mcdonald="" et="" al="" studied="" 1220="" propensity-matched="" pairs="" with=""><60 ml/="" min/1.73m2,="" requiring="" two="" available="" scr="" values="" 24="" hours="" prior="" to="" ct,="" potentially="" selecting="" for="" sicker="" patients.16="" of="" these="" studies,="" only="" davenport="" et="" al="" identified="" increased="" aki="" odds="" for="" cect="" among="" patients="" with=""><30 ml/min/1.73m2="" (2.96;="" 95%="" ci,="" 1.22-7.17).7="" in="" our="" study,="" the="" ckd="" stage="" aligned="" closely="" but="" not="" perfectly="" with="" baseline="" egfr,="" and="" sensitivity="" analyses="" of="" separately="" derived="" egfr="" cohorts="" were="" consistent="" with="" ckd="" stage-based="" findings.="" the="" small="" subgroup="" of="" severe="" ckd="" or="" very="" low="" egfr="" suggests="" that="" patients="" with="" very="" abnormal="" renal="" function="" may="" be="" unlikely="" to="" receive="" iv="" contrast,="" and="" statistical="" power="" was="" limited="" in="" this="" subgroup="" in="" our="">

Cov txiaj ntsig ntawm tus neeg mob nyob rau hauv cov txiaj ntsig ntawm kev lim ntshav tshiab, ESRD, thiab kev tuag yog qhov nyuaj rau kev soj ntsuam vim tias qhov tsis txaus ntseeg nce ntxiv nrog lub sijhawm tom qab qhov sib piv tsis tau tseem yog qhov tseem ceeb hauv kev kho mob. Kev ntsuas kev hloov pauv hauv lub raum ua haujlwm tuaj yeem ua rau poob qis ntawm lub cev raug mob, 33 tseem lub ntsiab lus ntawm AKI tso siab rau kev ntsuas serial sCr; Qhov teeb meem no siv tau rau txhua qhov kev tshawb nrhiav ntawm AKI thiab qhia txog qhov tseem ceeb ntawm kev soj ntsuam cov txiaj ntsig ntawm kev kho mob thiab cov neeg mob hauv nruab nrab nrog rau qhov ntsuas qhov ntsuas. Peb tau soj ntsuam tsis tu ncua kev lim ntshav tsis tu ncua thiab kev kuaj mob ESRD tshiab, tejzaum nws muaj feem cuam tshuam nrog qhov xwm txheej me me-txhim kho lub zog ntawm cov lej, coding lags, thiab qhov tsis sib xws hauv cov kev tsis sib haum xeeb. Hauv kev txheeb xyuas meta-analyses ntawm AKI thiab cov txiaj ntsig thib ob, kev tuag tsis zoo sib xws (0.998, 95 feem pua ​​​​CI, 0.730-1.362) ntawm txhua tus neeg mob, tsis tau CKD cov neeg mob tuaj yeem tau nce kev pheej hmoo tuag tsis hais txog CT.14.

Kev tuag hauv peb pawg neeg yog qhov tseem ceeb rau ob qho tib si tsis sib xws thiab CECT, yuav yog vim xaiv qhov muaj ntawm serial sCr ntsuas. Kev tshuaj xyuas tsis ntev los no qhia txog qhov teeb meem no hauv kev nkag siab txog qhov hloov pauv SCR hloov pauv, cov txiaj ntsig ntawm tus neeg mob thib ob, thiab kev sib raug zoo ntawm ob, qhia tias kev ntsuas lub raum raug mob ntsig txog qhov sib txawv yog txwv ob qho tib si los ntawm cov lus nug tseem ceeb ntawm kev hloov pauv tom qab CT sCr thiab los ntawm Qhov ua tau tsis meej pem hauv kev tshaj tawm cov txiaj ntsig ntev dua.34 Cov kev soj ntsuam hauv txoj kev tshawb fawb tam sim no ntawm cov txiaj ntsig theem nrab qis dua txawm hais tias qhov xwm txheej ntawm AKI tau sau tseg txij li 8.3 feem pua ​​(tsis sib piv) mus rau 13.2 feem pua ​​(CECT) qhia tias AKI yuav tsis txhais mus rau kev kho mob tseem ceeb rau lub raum raug mob tom qab IV sib piv. Kev kawm txog lwm cov txiaj ntsig xws li 30-hnub lub raum ua haujlwm rov qab los yog cov tswv yim los kwv yees AKI qhov kev pheej hmoo thiab qhov xav tau rau kev soj ntsuam tom qab CT lub raum yuav muaj feem cuam tshuam rau kev kho mob. Ib qho kev kawm yav tom ntej los yog ib qho qauv loj dua yuav tsim nyog los ntsuas qhov tseeb ntawm cov txiaj ntsig ntawm tus neeg mob.

TXOJ CAI

Peb txoj kev tshawb fawb muaj ntau yam kev txwv. Kev suav nrog thiab kev tsim nyog tau txais kev txwv txwv peb pawg neeg kawm. Txawm hais tias peb tsis tuaj yeem hloov kho rau CT qhov taw qhia, qhov sib piv cov qhab nia sib piv yuav yog qhov ua tau zoo tshaj plaws rov qab mus rau qhov sib npaug rau kev kho mob (kev sib piv); IV qhov sib txawv yog lim los ntawm ob lub raum zoo ib yam li qhov qhia txog qhov sib txawv ntawm IV. Txawm li cas los xij, txoj hauv kev rov qab tsis tuaj yeem cuam tshuam qhov cuam tshuam ntawm qhov sib txawv thiab cov txheej txheem kab mob uas tau txheeb xyuas los ntawm CT kuaj. Intra-arterial contrast tsis tau kawm hauv qhov kev tshawb nrhiav no. Peb tau saib xyuas los xaiv CT cov kev tshawb fawb uas tau ua nrog thiab tsis muaj qhov sib txawv IV thaum tsis muaj kev tshawb fawb yav tom ntej uas yuav tso cai rau qee hom kev sib txawv ntawm qhov sib txawv thiab tsis suav nrog CTs, uas feem ntau yog cov kev tshawb fawb tsis sib xws. Qhov ua tiav ntawm sCr qhov tseem ceeb raug txwv, zoo ib yam li cov kev tshawb fawb yav dhau los, thiab tej zaum yuav raug ntsuas sib txawv tom qab CT hauv cov neeg mob mob.7,8,10,28 Peb tau hais txog qhov muaj peev xwm rau lub raum tsis ua haujlwm los ntawm kev ntsuas ua ntej CT sCr thiab sib piv rau lub raum ua haujlwm. thaum lub sijhawm CT. CKD 4-5 pawg pab pawg qhia txog cov teeb meem hauv kev sib piv rov qab sib piv: CKD 4-5 qhov muaj feem ntau yog 3 feem pua ​​(186 CECT thiab 186 tsis sib xws) hauv pawg neeg sib raug zoo, thiab txoj kev tshawb no tsis muaj lub zog los ntsuas cais pab pawg no.

Cov neeg mob tsawg tsawg hauv cov kab mob hauv lub raum hnyav tshaj plaws (CKD 4-5) pawg tau ua rau muaj kev ntxub ntxaug tsis txaus los txheeb xyuas qhov kev pheej hmoo AKI, tab sis cov kev tshawb pom no qhia tias cov kws kho mob zam kom tsis txhob muaj IV-kev sib piv rau cov neeg mob raum mob hnyav txawm tias ua ntej. Cov ntaub ntawv qhia txog qhov kev pheej hmoo tsis txaus ntseeg ntawm AKI, thiab qhov txiaj ntsig tom qab qhov sib txawv hauv cov neeg mob uas muaj lub raum tsis ua haujlwm tau lees paub ntxiv kev kawm ntxiv. Tej zaum peb yuav tsis tau ntes tag nrho cov kev sib txawv uas cuam tshuam hauv qhov kev rho tawm hluav taws xob rov qab no, tab sis peb suav nrog ntau yam piav qhia txog AKI kev pheej hmoo; Yog li ntawd, peb tsis txhob cia siab tias peb txoj kev tshawb fawb no muaj ntau qhov kev tsis ncaj ncees dua li kev tshawb nrhiav yav dhau los.7,8,10,11,18,21

XAIV

Hauv cov ntsiab lus, peb pom muaj kev pheej hmoo tag nrho ntawm mob raum raug mob tom qab sib piv CT hauv pawg neeg mob uas paub txog kab mob raum. Qhov cuam tshuam loj heev hauv peb thiab lwm yam kev tshawb fawb, ua ke nrog peb cov kev tshawb pom ntawm cov mob raum raug mob siab dua ntawm cov neeg mob uas muaj kab mob raum ntev, qhia tias kev tshawb fawb yav tom ntej hauv cov neeg muaj npe tshwj xeeb no xav tau. Txawm hais tias tsis zoo li qhov tsis zoo, kev nrhiav neeg ua haujlwm rau cov neeg mob CT yuav pab txhawb kev ntsuas cov ntshav creatinine thiab ntsuas cov txiaj ntsig zoo xws li 30-hnub lub raum ua haujlwm rov qab.

Txhim kho lub raum ua haujlwm: cistanche

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