Hix John Kevin, Thakar Charuhas V, Katz Ethan M, Yared Jean-Pierre, Sabik Joseph, Paganini Emil P
Departments of Nephrology and Hypertension, Cleveland Clinic Foundation, Cleveland, OH, USA.
Crit Care Med. 2006 Dec;34(12):2979-83. doi: 10.1097/01.CCM.0000248905.67352.BA.
Risk of mortality after cardiac surgery is associated with severity of acute kidney injury. The aim of this study is to examine the effect of off-pump coronary artery bypass surgery on the risk of postoperative acute kidney injury and its association with mortality.
Observational cohort study.
Tertiary care center.
Some 10,061 patients underwent coronary artery bypass surgery (1998-2002), of which 1,365 patients underwent off-pump surgery.
Acute kidney injury was defined as either requirement of dialysis or >/=50% decline in postoperative glomerular filtration rate but not requiring dialysis. We compared on- and off-pump surgeries and used propensity score matching to examine the effect of off-pump surgery on acute kidney injury and mortality.
We found that 2.6% on-pump and 1.2% off-pump patients developed acute kidney injury requiring dialysis among the 2,370 matched subjects (relative risk, 2.06; 95% confidence interval [CI], 1.36-3.36); 5.0% of on-pump patients suffered a >/=50% decline in glomerular filtration rate compared with 2.5% in off-pump group (relative risk, 2.00; 95% CI, 1.48-2.82). The mortality rate in the matched cohort was 2.3% for on-pump group vs. 0.6% in off-pump group (relative risk, 3.88; 95% CI, 2.29-9.50). Among matched patients with acute kidney injury, the risk of mortality was 13.14 (95% CI, 8.43-30.50) in patients requiring dialysis and 9.33 (95% CI, 4.83-19.00) in those with >/=50% decline in glomerular filtration rate but not requiring dialysis.
Off-pump surgery is associated with a lower risk of developing acute kidney injury (regardless of its definition). The risk of mortality is incremental with worsening degrees of acute kidney injury. Lower risk of acute kidney injury may be one of the factors that offer a survival advantage after off-pump surgery.
心脏手术后的死亡风险与急性肾损伤的严重程度相关。本研究旨在探讨非体外循环冠状动脉搭桥手术对术后急性肾损伤风险的影响及其与死亡率的关联。
观察性队列研究。
三级医疗中心。
约10,061例患者接受了冠状动脉搭桥手术（1998 - 2002年），其中1,365例患者接受了非体外循环手术。
急性肾损伤定义为需要透析或术后肾小球滤过率下降≥50%但不需要透析。我们比较了体外循环和非体外循环手术，并使用倾向评分匹配来研究非体外循环手术对急性肾损伤和死亡率的影响。
在2370例匹配的受试者中，我们发现体外循环患者中有2.6%、非体外循环患者中有1.2%发生了需要透析的急性肾损伤（相对风险，2.06；95%置信区间[CI]，1.36 - 3.36）；体外循环患者中有5.0%的肾小球滤过率下降≥50%，而非体外循环组为2.5%（相对风险，2.00；95% CI，1.48 - 2.82）。匹配队列中，体外循环组的死亡率为2.3%，非体外循环组为0.6%（相对风险，3.88；95% CI，2.29 - 9.50）。在发生急性肾损伤的匹配患者中，需要透析的患者死亡率风险为13.14（95% CI，8.43 - 30.50），肾小球滤过率下降≥50%但不需要透析的患者死亡率风险为9.33（95% CI，4.83 - 19.00）。
非体外循环手术发生急性肾损伤的风险较低（无论其定义如何）。死亡率风险随着急性肾损伤程度的加重而增加。急性肾损伤风险较低可能是为非体外循环手术后带来生存优势的因素之一。
