Kilo Juliane, Margreiter Josef E, Ruttmann Elfriede, Laufer Guenther, Bonatti Johannes O
Department of Anesthesia and Intensive Care Medicine, University of Innsbruck, Innsbruck, Austria.
Heart Surg Forum. 2005;8(1):E34-8. doi: 10.1532/HSF98.20041117.
Acute renal failure (ARF) after cardiac surgery is a serious adverse event that is associated with high perioperative mortality and prolonged hospitalization. The aim of our study was to evaluate pre- and intraoperative risk factors for the development of ARF requiring hemofiltration after cardiac surgery.
From February 2002 through February 2003, 913 patients underwent cardiac surgery at our institution. Seventy-three patients developed ARF (8.1%), 16 patients were excluded from the study because of chronic end-stage renal insufficiency. Patient characteristics and operative variables were analyzed. A multivariate logistic regression analysis was performed to determine risk factors for ARF.
Patients who developed ARF were older (P < .001; odds ratio [OR], 1.084; 95% confidence interval [CI], 1.0371.133) than patients who did not develop ARF. Furthermore, cardiopulmonary bypass duration (P = .007; OR, 1.013; 95% CI, 1.004-1.032) and emergent surgery (P = .011; OR, 6.667; CI, 1.538-28.571) were predictive for development of ARF. The strongest predictor for ARF was a preoperative creatinine level >or=2 mg/dL (P < .001; OR, 97.519; 95% CI, 22.363425.252). Most interestingly, even moderately elevated preoperative creatinine levels (1.3-1.99 mg/dL) independently predict ARF after cardiac surgery (P = .001; OR, 3.838; 95% CI, 1.793-8.217).
Our data indicate that emergent surgery as well as advanced age and long duration of cardiopulmonary bypass independently predict ARF after cardiac surgery. Most importantly, even slightly impaired preoperative creatinine levels predict the development of ARF requiring hemofiltration after cardiac surgery.
心脏手术后急性肾衰竭（ARF）是一种严重的不良事件，与围手术期高死亡率及延长住院时间相关。我们研究的目的是评估心脏手术后发生需要血液滤过的ARF的术前及术中危险因素。
2002年2月至2003年2月期间，913例患者在我们机构接受心脏手术。73例患者发生ARF（8.1%），16例因慢性终末期肾功能不全被排除在研究之外。分析患者特征及手术变量。进行多因素逻辑回归分析以确定ARF的危险因素。
发生ARF的患者比未发生ARF的患者年龄更大（P <.001；比值比[OR]，1.084；95%置信区间[CI]，1.037 - 1.133）。此外，体外循环时间（P =.007；OR，1.013；95% CI，1.004 - 1.032）及急诊手术（P =.011；OR，6.667；CI，1.538 - 28.571）可预测ARF的发生。ARF最强的预测因素是术前肌酐水平≥2 mg/dL（P <.001；OR，97.519；95% CI，22.363 - 425.252）。最有趣的是，即使术前肌酐水平轻度升高（1.3 - 1.99 mg/dL）也可独立预测心脏手术后的ARF（P =.001；OR，3.838；95% CI，1.793 - 8.217）。
我们的数据表明急诊手术以及高龄和体外循环时间长可独立预测心脏手术后的ARF。最重要的是，即使术前肌酐水平稍有受损也可预测心脏手术后需要血液滤过的ARF的发生。
