Najafi Mahdi, Goodarzynejad Hamidreza, Karimi Abbasali, Ghiasi Abbas, Soltaninia Hasan, Marzban Mehrab, Salehiomran Abbas, Alinejad Banafsheh, Soleymanzadeh Maryam
Department of Anesthesiology, Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran.
J Thorac Cardiovasc Surg. 2009 Feb;137(2):304-8. doi: 10.1016/j.jtcvs.2008.08.001. Epub 2008 Sep 19.
Evaluating renal function by calculating creatinine clearance as an alternative measure to serum creatinine may give a better estimation of postoperative renal function in patients undergoing coronary artery bypass grafting.
Using our database, we conducted a retrospective review of the records of all 11,884 patients aged 21 years or older undergoing pure bypass grafting who required cardiopulmonary bypass. Preoperative renal function was categorized as normal renal function (serum creatinine </=1.1 mg/dL and creatinine clearance > 60 mL/min), occult renal insufficiency (serum creatinine </= 1.1 mg/dL and creatinine clearance </= 60 mL/min), mild renal insufficiency (1.1 mg/dL < serum creatinine </= 1.5 mg/dL and creatinine clearance </= 60 mL/min) or moderate renal insufficiency (serum creatinine > 1.5 mg/dL and creatinine clearance </= 60 mL/min).
Out of 11,884 patients in the sample, 7856 (66.1%) had normal renal function, and 706 (5.9%) had occult renal insufficiency. The rate of postoperative mortality, renal failure, atrial fibrillation, prolonged ventilation, intra-aortic balloon pump usage, and prolonged hospital stay (>7 days) was higher in patients with occult renal insufficiency than in the normal group in univariable analysis. Multivariable logistic regression analysis demonstrated that patients with occult renal insufficiency compared with the group with normal renal function were at higher risk for mortality (odds ratio = 2.59, 95% confidence interval 1.15-5.86; P = .022) and prolonged hospital stay (>7 d) (odds ratio = 1.30, 95% confidence interval 1.08-1.57; P = .005).
To identify higher-risk patients requiring special intensive care, and in whom new interventions can be performed to improve outcome, we recommend the preoperative calculation of creatinine clearance, especially in older women with a lower body mass index.
通过计算肌酐清除率来评估肾功能，作为血清肌酐的替代指标，可能会更好地估计接受冠状动脉搭桥术患者的术后肾功能。
利用我们的数据库，对所有11884例年龄在21岁及以上、接受单纯搭桥术且需要体外循环的患者的记录进行回顾性分析。术前肾功能分为正常肾功能（血清肌酐≤1.1mg/dL且肌酐清除率>60mL/min）、隐匿性肾功能不全（血清肌酐≤1.1mg/dL且肌酐清除率≤60mL/min）、轻度肾功能不全（1.1mg/dL<血清肌酐≤1.5mg/dL且肌酐清除率≤60mL/min）或中度肾功能不全（血清肌酐>1.5mg/dL且肌酐清除率≤60mL/min）。
在样本中的11884例患者中，7856例（66.1%）肾功能正常，706例（5.9%）有隐匿性肾功能不全。在单因素分析中，隐匿性肾功能不全患者的术后死亡率、肾衰竭、房颤、通气时间延长、主动脉内球囊泵使用及住院时间延长（>7天）的发生率高于正常组。多因素logistic回归分析显示，隐匿性肾功能不全患者与肾功能正常组相比，死亡风险更高（比值比=2.59，95%置信区间1.15-5.86；P=0.022），住院时间延长（>7天）的风险也更高（比值比=1.30，95%置信区间1.08-1.57；P=0.005）。
为了识别需要特殊重症监护且可进行新干预措施以改善预后的高危患者，我们建议术前计算肌酐清除率，尤其是在体重指数较低的老年女性中。
