Abstract：
Augmented renal clearance or glomerular hyperfiltration (GHF) can significantly affect the clinical outcomes of renally eliminated drugs by promoting subtherapeutic drug exposure. The aggression suffered in patients who suffer severe trauma is a predisposition to manifest GHF and the identification of these patients remains a clinical challenge. The main objective of this study was to describe the prevalence of GHF in a cohort of critically ill trauma patients.
Prospective observational study of a cohort of adult patients admitted after suffering severe trauma or polytrauma in the Anesthesiology ICU of the University Hospital of Albacete (Spain). Creatinine clearance (ClCr) was calculated in a 4-h urine collection sample at 24, 72 and 168 h after admission applying the formula; CrCl: [Diuresis in ml (urine/4 h) × Creatinine in urine (mg/dl)] ÷ [240 (minutes) × Creatinine in plasma (mg/dl)]. A CrCl above 130 mL/min was considered GHF. The analyses were performed with the statistical software R version 4.0.4.
85 patients were included. The median age of the patients was 51 years (IQR 26), 78.82% male. 68 patients were male (78.82%). 75.29% of the patients were polytraumatized. 61 patients (71.76%) presented GHF at some point in the CrCl determination. At 24 h of admission, 56.34% of the patients presented GHF with a mean CrCl of 195.8 ml/min, 61.11% of the patients presented it at 72 h with a mean CrCl of /min and 56.52% presented GHF at 168 h of admission with a mean CrCl of 207 ml/min. A significant positive relationship (p = 0.07) was found between GHF manifested at 72 h and at 168 h. We observed a statistically significant relationship between this phenomenon with younger ages, lower ISS scores and lower plasma creatinines.
GHF are a common condition in critically ill patients admitted for severe trauma. We recommend the use of CrCl to assess renal function and make dosage adjustments. Studies are required to understand the clinical impact of these phenomena on drug elimination and to be able to establish the ideal dosage in those cases.
Prospective observational study of a cohort of adult patients admitted after suffering severe trauma or polytrauma in the Anesthesiology ICU of the University Hospital of Albacete (Spain). Creatinine clearance (ClCr) was calculated in a 4-h urine collection sample at 24, 72 and 168 h after admission applying the formula; CrCl: [Diuresis in ml (urine/4 h) × Creatinine in urine (mg/dl)] ÷ [240 (minutes) × Creatinine in plasma (mg/dl)]. A CrCl above 130 mL/min was considered GHF. The analyses were performed with the statistical software R version 4.0.4.
85 patients were included. The median age of the patients was 51 years (IQR 26), 78.82% male. 68 patients were male (78.82%). 75.29% of the patients were polytraumatized. 61 patients (71.76%) presented GHF at some point in the CrCl determination. At 24 h of admission, 56.34% of the patients presented GHF with a mean CrCl of 195.8 ml/min, 61.11% of the patients presented it at 72 h with a mean CrCl of /min and 56.52% presented GHF at 168 h of admission with a mean CrCl of 207 ml/min. A significant positive relationship (p = 0.07) was found between GHF manifested at 72 h and at 168 h. We observed a statistically significant relationship between this phenomenon with younger ages, lower ISS scores and lower plasma creatinines.
GHF are a common condition in critically ill patients admitted for severe trauma. We recommend the use of CrCl to assess renal function and make dosage adjustments. Studies are required to understand the clinical impact of these phenomena on drug elimination and to be able to establish the ideal dosage in those cases.
摘要：
目的：增加肾清除或肾小球高滤过（GHF）可通过促进亚治疗药物暴露来显著影响肾清除药物的临床结局。遭受严重创伤的患者遭受的侵略是表现出GHF的倾向，对这些患者的识别仍然是临床挑战。这项研究的主要目的是描述重症创伤患者队列中GHF的患病率。
方法：对在阿尔巴塞特大学医院（西班牙）麻醉科ICU遭受严重创伤或多创伤后入院的成年患者进行前瞻性观察研究。在入院后24、72和168小时的4小时尿液收集样本中计算肌酐清除率（ClCr），并应用以下公式：CrCl：[以ml为单位的利尿（尿/4小时）×尿液中的肌酐（mg/dl）]÷[240（分钟）×血浆中的肌酐（mg/dl）]。高于130mL/min的CrCl被认为是GHF。用4.0.4版统计软件R进行分析。
结果：纳入85例患者。患者的中位年龄为51岁（IQR26），78.82%男性。68例患者为男性（78.82%）。75.29%的患者为多发伤。61名患者（71.76％）在CrCl测定中的某个时间点出现GHF。入院24小时时，56.34％的患者出现GHF，平均CrCl为195.8ml/min，61.11％的患者在72h时出现GHF，平均CrCl为/min，56.52％的患者在入院168h时出现GHF，平均CrCl为207ml/min。发现GHF在72h和168h之间存在显着正相关（p=0.07）。我们观察到这种现象与年轻年龄之间存在统计学上的显着关系，较低的ISS评分和较低的血浆肌酸。
结论：GHF是因严重创伤而入院的危重患者的常见病。我们建议使用CrCl评估肾功能并进行剂量调整。需要进行研究以了解这些现象对药物消除的临床影响，并能够在这些情况下确定理想的剂量。
方法：对在阿尔巴塞特大学医院（西班牙）麻醉科ICU遭受严重创伤或多创伤后入院的成年患者进行前瞻性观察研究。在入院后24、72和168小时的4小时尿液收集样本中计算肌酐清除率（ClCr），并应用以下公式：CrCl：[以ml为单位的利尿（尿/4小时）×尿液中的肌酐（mg/dl）]÷[240（分钟）×血浆中的肌酐（mg/dl）]。高于130mL/min的CrCl被认为是GHF。用4.0.4版统计软件R进行分析。
结果：纳入85例患者。患者的中位年龄为51岁（IQR26），78.82%男性。68例患者为男性（78.82%）。75.29%的患者为多发伤。61名患者（71.76％）在CrCl测定中的某个时间点出现GHF。入院24小时时，56.34％的患者出现GHF，平均CrCl为195.8ml/min，61.11％的患者在72h时出现GHF，平均CrCl为/min，56.52％的患者在入院168h时出现GHF，平均CrCl为207ml/min。发现GHF在72h和168h之间存在显着正相关（p=0.07）。我们观察到这种现象与年轻年龄之间存在统计学上的显着关系，较低的ISS评分和较低的血浆肌酸。
结论：GHF是因严重创伤而入院的危重患者的常见病。我们建议使用CrCl评估肾功能并进行剂量调整。需要进行研究以了解这些现象对药物消除的临床影响，并能够在这些情况下确定理想的剂量。
