Nurse-led dynamic urine monitoring reduces acute kidney injury in patients with severe hymenoptera stings: a historically controlled retrospective study.

BACKGROUND: To investigate the association of a nurse-led dynamic urine monitoring protocol with acute kidney injury (AKI) risk and clinical outcomes in patients with severe hymenoptera stings. METHODS: A historically controlled retrospective design was adopted, with nurse-led dynamic urine monitoring protocol implementation date (January 1, 2022) as the cutoff. Patients were divided into historical control (2019-2021) and dynamic monitoring (2022-2024) groups. The protocol included objective urine color grading, high-frequency dynamic recording, and a standardized situation-background-assessment-recommendation escalation protocol. After propensity score matching was used to balance baseline covariates, AKI incidence and intervention timeliness were compared. Multivariate logistic regression was used to assess the independent association of nurse-led dynamic urine monitoring protocol with AKI risk. RESULTS: Post-propensity score matching, 260 patients were included. Compared with the historical control group, the dynamic monitoring group had lower overall AKI incidence (33.8% vs. 52.3%, P = .003) and fewer patients progressing to severe AKI (Kidney Disease Improving Global Outcomes [KDIGO] stages 2-3; 27.7% vs. 42.3%, P = .013). Regarding response timeliness, the dynamic monitoring group showed shorter times to initiate urine alkalinization and achieve target fluid resuscitation volume, as well as a shorter length of stay in the emergency intensive care unit ([ICU]; all P < .001). Nurse-led dynamic urine monitoring protocol was independently associated with a lower AKI risk (odds ratio [OR] = 0.409, 95% confidence interval [CI]: 0.232-0.720, P = .002). CONCLUSION: Nurse-led dynamic urine monitoring protocol implementation is independently associated with reduced AKI incidence and shorter emergency ICU length of stay in patients with severe hymenoptera stings. By enabling early recognition and standardized response, nurse-led dynamic urine monitoring protocol is a potentially effective strategy for refined nursing care in this high-risk population.