Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, N.C. 27710, USA.
Blood Purif. 2009;28(4):359-63. doi: 10.1159/000235856. Epub 2009 Sep 1.
BACKGROUND/AIMS: Acute renal failure is associated with a high risk of mortality when it complicates coronary artery bypass graft (CABG) surgery. We examined a large nationwide database from 1988 to 2003 and hypothesized that mortality in CABG-associated acute renal failure needing dialysis (ARF-D) had declined during this period.
The Nationwide Inpatient Sample containing data on inpatient stays across 20% of US hospitals was used for our study. Multivariate logistic regression was used to determine an association between year and ARF-D mortality with standardized risk adjustment.
Incidence of ARF-D increased from 0.2 to 0.6% while mortality simultaneously decreased from 47.4% in 1988 to 29.7% in 2003. In the multivariable model, year was significantly associated with declining ARF-D mortality.
The incidence of post-CABG ARF-D more than doubled from 1988 to 2003, while mortality simultaneously decreased by over one-third. Improved survival after ARF-D following CABG may be counterbalanced by increased morbidity and resource utilization.
背景/目的：急性肾衰竭并发冠状动脉旁路移植术（CABG）时，死亡率很高。我们检查了 1988 年至 2003 年的一个大型全国性数据库，并假设在此期间，需要透析的 CABG 相关急性肾衰竭（ARF-D）的死亡率有所下降。
本研究使用了包含全美 20%医院住院数据的全国住院患者样本。采用多变量逻辑回归来确定年份与 ARF-D 死亡率之间的关联，并进行标准化风险调整。
ARF-D 的发生率从 0.2%增加到 0.6%，而死亡率同时从 1988 年的 47.4%下降到 2003 年的 29.7%。在多变量模型中，年份与 ARF-D 死亡率的下降显著相关。
1988 年至 2003 年，CABG 后 ARF-D 的发病率增加了一倍以上，而死亡率同时下降了三分之一以上。CABG 后 ARF-D 的生存率提高可能被发病率和资源利用的增加所抵消。
