Fluid resuscitation is frequently required for cardiac surgical patients admitted to the intensive care unit. The ideal fluid of choice in regard to efficacy and safety remains uncertain. Compared with crystalloid fluid, colloid fluid may result in less positive fluid balance. However, some synthetic colloids are associated with increased risk of acute kidney injury (AKI). This study compared the effects of succinylated gelatin (4%) (GEL) with compound sodium lactate (CSL) on urinary AKI biomarkers in patients after cardiac surgery. Cardiac surgical patients who required an intravenous fluid bolus of at least 500 mL postoperatively were randomly allocated to receive GEL or CSL as the resuscitation fluid of choice for the subsequent 24 h. Primary outcomes were serial urinary neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C concentrations measured at baseline, 1 h, 5 h and 24 h after enrolment, with higher concentrations indicating greater kidney injury. Secondary biomarker outcomes included urinary clusterin, α1-microglobulin and F2-isoprostanes concentrations. Differences in change of biomarker concentration between the two groups over time were compared with mixed-effects regression models. Statistical significance was set at P < 0.05. Forty cardiac surgical patients (n = 20 per group) with similar baseline characteristics were included. There was no significant difference in the median volume of fluid boluses administered over 24 h between the GEL (1250 mL, Q1–Q3 500–1750) and CSL group (1000 mL, Q1–Q3 500–1375) (P = 0.42). There was a significantly greater increase in urinary cystatin C (P < 0.001), clusterin (P < 0.001), α1-microglobulin (P < 0.001) and F2-isoprostanes (P = 0.020) concentrations over time in the GEL group, compared to the CSL group. Change in urinary NGAL concentration (P = 0.68) over time was not significantly different between the groups. The results were not modified by adjustment for either urinary osmolality or EuroSCORE II predicted risk of mortality. This preliminary randomised controlled trial showed that use of succinylated gelatin (4%) for fluid resuscitation after cardiac surgery was associated with increased biomarker concentrations of renal tubular injury and dysfunction, compared to crystalloid fluid. These results generate concern that use of intravenous gelatin fluid may contribute to clinically relevant postoperative AKI. Trial registration ANZCTR.org.au, ACTRN12617001461381. Registered on 16th October, 2017, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373619&isReview=true .

中文翻译：

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琥珀酰明胶 (4%) 液体对心脏手术患者尿急性肾损伤生物标志物的随机对照试验

入住重症监护病房的心脏手术患者经常需要液体复苏。就疗效和安全性而言，理想的液体选择仍然不确定。与晶体液相比，胶体液可能导致较少的液体正平衡。然而，一些合成胶体与急性肾损伤 (AKI) 的风险增加有关。本研究比较了琥珀酰明胶 (4%) (GEL) 与复方乳酸钠 (CSL) 对心脏手术后患者尿 AKI 生物标志物的影响。术后需要静脉推注至少 500 mL 液体的心脏外科患者被随机分配接受 GEL 或 CSL 作为随后 24 小时的首​​选复苏液。主要结果是在基线、入组后 1 小时、5 小时和 24 小时测量的系列尿中性粒细胞明胶酶相关脂质运载蛋白 (NGAL) 和胱抑素 C 浓度，浓度越高表明肾损伤越大。次要生物标志物结果包括尿凝聚素、α1-微球蛋白和 F2-异前列腺素浓度。将两组之间生物标志物浓度随时间变化的差异与混合效应回归模型进行比较。统计显着性设定为 P < 0.05。包括具有相似基线特征的 40 名心脏手术患者（每组 n = 20）。GEL（1250 mL，Q1-Q3 500-1750）和 CSL 组（1000 mL，Q1-Q3 500-1375）之间在 24 小时内注射的液体推注的中位数没有显着差异（P = 0.42）。与 GEL 组相比，随着时间的推移，尿胱抑素 C (P < 0.001)、凝聚蛋白 (P < 0.001)、α1-微球蛋白 (P < 0.001) 和 F2-异前列腺素 (P = 0.020) 浓度显着增加CSL 组。各组间尿 NGAL 浓度随时间的变化 (P = 0.68) 无显着差异。结果未通过调整尿渗透压或 EuroSCORE II 预测的死亡风险而修改。这项初步随机对照试验表明，与晶体液相比，在心脏手术后使用琥珀酰明胶 (4%) 进行液体复苏与肾小管损伤和功能障碍的生物标志物浓度增加有关。这些结果令人担心使用静脉注射明胶液可能会导致临床相关的术后 AKI。试验注册 ANZCTR.org.au, ACTRN12617001461381。2017 年 10 月 16 日注册，http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373619&isReview=true。