Background

Augmented renal clearance (ARC) remains poorly evaluated in ICU. The objective of this study is to provide a full description of ARC in ICU including prevalence, evolution profile, risk factors and outcomes.

Methods

This was a retrospective, single-center, observational study. All the patients older than 18 years admitted for the first time in Medical ICU, Bichat, University Hospital, APHP, France, between January 1, 2017, and November 31, 2020 and included into the Outcomerea database with an ICU length of stay longer than 72 h were included. Patients with chronic kidney disease were excluded. Glomerular filtration rate was estimated each day during ICU stay using the measured creatinine renal clearance (CrCl). Augmented renal clearance (ARC) was defined as a 24 h CrCl greater than 130 ml/min/m².

Results

312 patients were included, with a median age of 62.7 years [51.4; 71.8], 106(31.9%) had chronic cardiovascular disease. The main reason for admission was acute respiratory failure (184(59%)) and 196(62.8%) patients had SARS-COV2. The median value for SAPS II score was 32[24; 42.5]; 146(44%) and 154(46.4%) patients were under vasopressors and invasive mechanical ventilation, respectively. The overall prevalence of ARC was 24.6% with a peak prevalence on Day 5 of ICU stay. The risk factors for the occurrence of ARC were young age and absence of cardiovascular comorbidities. The persistence of ARC during more than 10% of the time spent in ICU was significantly associated with a lower risk of death at Day 30.

Conclusion

ARC is a frequent phenomenon in the ICU with an increased incidence during the first week of ICU stay. Further studies are needed to assess its impact on patient prognosis.

中文翻译：

---

ICU中肾清除率增加：估计、发生率、危险因素和后果——一项回顾性观察研究

背景

增强型肾清除率 (ARC) 在 ICU 中的评估仍然很差。本研究的目的是提供 ICU 中 ARC 的完整描述，包括患病率、演变概况、风险因素和结果。

方法

这是一项回顾性、单中心、观察性研究。所有 18 岁以上的患者在 2017 年 1 月 1 日至 2020 年 11 月 31 日期间首次入住法国 APHP 大学医院的医学 ICU，并纳入 Outcomerea 数据库，ICU 停留时间超过包括 72 小时。排除慢性肾病患者。使用测量的肌酐肾清除率 (CrCl) 在 ICU 期间每天估计肾小球滤过率。增强的肾清除率 (ARC) 定义为 24 小时 CrCl 大于 130 ml/min/m ²。

结果

纳入 312 名患者，中位年龄为 62.7 岁 [51.4; 71.8], 106 (31.9%) 患有慢性心血管疾病。入院的主要原因是急性呼吸衰竭（184例（59%）），196例（62.8%）患者感染了SARS-COV2。SAPS II 评分的中值为 32[24; 42.5]；分别有 146 (44%) 和 154 (46.4%) 名患者接受血管加压药和有创机械通气。ARC 的总患病率为 24.6%，在 ICU 住院第 5 天达到最高患病率。发生 ARC 的危险因素是年轻和无心血管合并症。在 ICU 中超过 10% 的时间持续存在 ARC 与第 30 天的较低死亡风险显着相关。

结论

ARC 是 ICU 中的常见现象，在入住 ICU 的第一周内发生率增加。需要进一步的研究来评估其对患者预后的影响。