Renal Division, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Nephron Clin Pract. 2011;117(4):c305-11. doi: 10.1159/000321171. Epub 2010 Sep 22.
BACKGROUND/AIMS: Acute kidney injury (AKI) following surgery is a major complication, but the prevalence and risk factors in the Asian population are unclear. Recently, a consensus definition of AKI (AKIN) was proposed. We studied a cohort of cardiac surgery patients and identified AKI by AKIN and associated risk factors.
We retrospectively evaluated 1,056 consecutive patients undergoing cardiac surgery in Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China from January 1, 2004 to June 30, 2007. We recorded AKIN stage, clinical characteristics, perioperative variables and complications, as well as clinical outcomes. Univariate and multivariate regression as well as survival analysis was performed.
AKI occurred in 328 (31.1%) patients, stage 1 in 21.1%, stage 2 in 6.3% and stage 3 in 3.7%. Patients with AKI were older (65.8 vs. 53.5 years, p < 0.001), more often male (66.8 vs. 54.1%, p < 0.001), and had higher Charlson Comorbidity Index (CCI) (CCI >2: 22.6 vs. 7.8%, p < 0.001). In logistic regression, advanced age (OR 1.48 per decade, 95% CI 1.32-1.67), CCI >2 (OR 2.82, 95% CI 1.80-4.41), hypertension (OR 2.13, 95% CI 1.47-3.09), left ventricular ejection fraction (LVEF) <45% (OR 1.97, 95% CI 1.14-3.40), postoperative central venous pressure (CVP) <6 cm H(2)O (OR 13.28, 95% CI 8.72-20.14) and postoperative use of ACEI/ARB (OR 1.90, 95% CI 1.27-2.85) were risk factors of AKI. Mortality rose progressively with increased AKIN stage (non-AKI 0.7%, stage 1 4.9%, stage 2 12.1% and stage 3 48.7%). In ROC analysis, AKIN classification was identified to be associated with in-hospital mortality with an AUC of 0.865 (95% CI 0.801-0.929, sensitivity 0.884, specificity 0.714, p < 0.001). Finally, in a Cox proportional hazards model, AKIN stage (HR 2.40, p < 0.001), re-exploration (HR 6.30, p = 0.002) and multiple organ dysfunction syndrome (MODS) (HR 4.42, p = 0.001) were associated risk factors for in-hospital mortality.
We evaluated AKIN as a marker of AKI and mortality risk in a large, unselected Chinese cohort of incident patients undergoing cardiac surgery. AKI following cardiac surgery was diagnosed by AKIN criteria in around one third of the patients, and AKI may be associated with outcome. The value of preventative strategies to reduce AKI and their effect on in-hospital mortality should be studied.
背景/目的：手术后急性肾损伤（AKI）是一种主要的并发症，但在亚洲人群中的患病率和危险因素尚不清楚。最近，提出了急性肾损伤的共识定义（AKIN）。我们研究了一组接受心脏手术的患者，并通过 AKIN 及其相关危险因素来确定 AKI。
我们回顾性评估了 2004 年 1 月 1 日至 2007 年 6 月 30 日期间在上海交通大学医学院附属仁济医院接受心脏手术的 1056 例连续患者。我们记录 AKIN 分期、临床特征、围手术期变量和并发症以及临床结局。进行单变量和多变量回归以及生存分析。
328 例（31.1%）患者发生 AKI，1 期 21.1%，2 期 6.3%，3 期 3.7%。AKI 患者年龄较大（65.8 岁 vs. 53.5 岁，p < 0.001），更多为男性（66.8% vs. 54.1%，p < 0.001），Charlson 合并症指数（CCI）更高（CCI >2：22.6% vs. 7.8%，p < 0.001）。在逻辑回归中，年龄增长（每十年增加 1.48，95%置信区间 1.32-1.67）、CCI >2（OR 2.82，95%CI 1.80-4.41）、高血压（OR 2.13，95%CI 1.47-3.09）、左心室射血分数（LVEF）<45%（OR 1.97，95%CI 1.14-3.40）、术后中心静脉压（CVP）<6 cm H2O（OR 13.28，95%CI 8.72-20.14）和术后使用 ACEI/ARB（OR 1.90，95%CI 1.27-2.85）是 AKI 的危险因素。AKIN 分期与住院死亡率呈递增趋势（非 AKI 0.7%，1 期 4.9%，2 期 12.1%和 3 期 48.7%）。在 ROC 分析中，AKIN 分类与院内死亡率相关，AUC 为 0.865（95%CI 0.801-0.929，敏感性 0.884，特异性 0.714，p < 0.001）。最后，在 Cox 比例风险模型中，AKIN 分期（HR 2.40，p < 0.001）、再次探查（HR 6.30，p = 0.002）和多器官功能障碍综合征（MODS）（HR 4.42，p = 0.001）是与院内死亡率相关的危险因素。
我们评估了 AKIN 作为接受心脏手术的中国大型未选择患者的 AKI 和死亡率风险的标志物。AKIN 标准诊断出大约三分之一的心脏手术后患者发生 AKI，AKI 可能与结局相关。应研究预防策略来减少 AKI 及其对院内死亡率的影响。
