Abstract：
BACKGROUND: Augmented renal clearance (ARC) is prevalent in trauma populations. Identification is underrecognized by calculated creatinine clearance or estimated glomerular filtration rate equations. Predictive scores may assist with ARC identification. The goal of this study was to evaluate validity of the ARCTIC score and ARC Predictor to predict ARC in critically ill trauma patients.
METHODS: This single center, retrospective study was performed at an academic level 1 trauma center. Critically ill adult trauma patients undergoing 24-h urine-collection were included. Patients with serum creatinine >1.5 mg/dL, kidney replacement therapy, suspected rhabdomyolysis, chronic kidney disease, or inaccurate urine collection were excluded. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for ARCTIC Score and ARC Predictor were calculated. Receiver operating characteristic curves were created for ARCTIC score and ARC Predictor models.
RESULTS: One-hundred and twenty-two patients with ARC and 78 patients without ARC were included. The ARCTIC score sensitivity, specificity, PPV, and NPV were 89%, 54%, 75%, and 75%, respectively. The ARC Predictor demonstrated sensitivity, specificity, PPV, and NPV of 77%, 88%, 91%, and 71%, respectively. Regression analyses revealed both ARCTIC score ≥6 and ARC Predictor threshold >0.5 as significant risk factors for ARC in presence of traumatic brain injury, obesity, injury severity score, and negative nitrogen balance (ARCTIC ≥6: odds ratio 8.59 [95% confidence interval 3.90-18.92], P < 0.001; ARC Predictor >0.5: odds ratio 20.07 [95% confidence interval 8.53-47.19], P < 0.001).
CONCLUSIONS: These findings corroborate validity of two pragmatic prediction tools to identify patients at high risk of ARC. Future studies evaluating correlations between ARCTIC score, ARC Predictor, and clinical outcomes are warranted.
METHODS: This single center, retrospective study was performed at an academic level 1 trauma center. Critically ill adult trauma patients undergoing 24-h urine-collection were included. Patients with serum creatinine >1.5 mg/dL, kidney replacement therapy, suspected rhabdomyolysis, chronic kidney disease, or inaccurate urine collection were excluded. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for ARCTIC Score and ARC Predictor were calculated. Receiver operating characteristic curves were created for ARCTIC score and ARC Predictor models.
RESULTS: One-hundred and twenty-two patients with ARC and 78 patients without ARC were included. The ARCTIC score sensitivity, specificity, PPV, and NPV were 89%, 54%, 75%, and 75%, respectively. The ARC Predictor demonstrated sensitivity, specificity, PPV, and NPV of 77%, 88%, 91%, and 71%, respectively. Regression analyses revealed both ARCTIC score ≥6 and ARC Predictor threshold >0.5 as significant risk factors for ARC in presence of traumatic brain injury, obesity, injury severity score, and negative nitrogen balance (ARCTIC ≥6: odds ratio 8.59 [95% confidence interval 3.90-18.92], P < 0.001; ARC Predictor >0.5: odds ratio 20.07 [95% confidence interval 8.53-47.19], P < 0.001).
CONCLUSIONS: These findings corroborate validity of two pragmatic prediction tools to identify patients at high risk of ARC. Future studies evaluating correlations between ARCTIC score, ARC Predictor, and clinical outcomes are warranted.
摘要：
背景：增加肾清除（ARC）在创伤人群中很普遍。通过计算的肌酐清除率或估计的肾小球滤过率方程式，识别不足。预测评分可以帮助ARC识别。这项研究的目的是评估ARCTIC评分和ARC预测因子预测危重创伤患者ARC的有效性。
方法：这个单一中心，回顾性研究是在学术一级创伤中心进行的.包括接受24小时尿液收集的重症成人创伤患者。血清肌酐>1.5mg/dL的患者，肾脏替代疗法,疑似横纹肌溶解症,慢性肾病,或不准确的尿液收集被排除。灵敏度,特异性，阳性预测值(PPV)，计算ARCTIC评分和ARC预测因子的阴性预测值(NPV)。为ARCTIC评分和ARC预测模型创建受试者工作特征曲线。
结果：纳入了122例ARC患者和78例无ARC患者。ARCTIC评分敏感度，特异性，PPV,净现值为89%，54%,75%,75%,分别。ARC预测器表现出灵敏度，特异性，PPV,净现值为77%，88%,91%,71%,分别。回归分析显示ARCTIC评分≥6和ARC预测阈值>0.5是创伤性脑损伤中ARC的重要危险因素。肥胖，损伤严重程度评分,和负氮平衡(ARCTIC≥6：赔率比8.59[95%置信区间3.90-18.92]，P<0.001；ARC预测值>0.5：比值比20.07[95%置信区间8.53-47.19]，P<0.001)。
结论：这些发现证实了两种实用预测工具在识别ARC高危患者中的有效性。未来的研究评估ARCTIC评分之间的相关性，ARC预测器,和临床结果是必要的。
方法：这个单一中心，回顾性研究是在学术一级创伤中心进行的.包括接受24小时尿液收集的重症成人创伤患者。血清肌酐>1.5mg/dL的患者，肾脏替代疗法,疑似横纹肌溶解症,慢性肾病,或不准确的尿液收集被排除。灵敏度,特异性，阳性预测值(PPV)，计算ARCTIC评分和ARC预测因子的阴性预测值(NPV)。为ARCTIC评分和ARC预测模型创建受试者工作特征曲线。
结果：纳入了122例ARC患者和78例无ARC患者。ARCTIC评分敏感度，特异性，PPV,净现值为89%，54%,75%,75%,分别。ARC预测器表现出灵敏度，特异性，PPV,净现值为77%，88%,91%,71%,分别。回归分析显示ARCTIC评分≥6和ARC预测阈值>0.5是创伤性脑损伤中ARC的重要危险因素。肥胖，损伤严重程度评分,和负氮平衡(ARCTIC≥6：赔率比8.59[95%置信区间3.90-18.92]，P<0.001；ARC预测值>0.5：比值比20.07[95%置信区间8.53-47.19]，P<0.001)。
结论：这些发现证实了两种实用预测工具在识别ARC高危患者中的有效性。未来的研究评估ARCTIC评分之间的相关性，ARC预测器,和临床结果是必要的。
