The Dartmouth Institute for Health Policy and Clinical Practice, Section of Cardiology, Dartmouth-Hitchcock Medical Center and Dartmouth Medical School, Lebanon, New Hampshire, USA.
Ann Thorac Surg. 2010 Oct;90(4):1142-8. doi: 10.1016/j.athoracsur.2010.04.039.
Acute kidney injury (AKI) after cardiac surgery is associated with worse outcomes. However, it is not known how adverse long-term consequences vary according to the duration of AKI. We sought to determine the association between duration of AKI and survival.
Medical records of 4,987 cardiac surgery patients from 2002 through 2007 with serum creatinine (SCr) collection at a medical center in northern New England were reviewed. Acute kidney injury was defined as at least a 0.3 (mg/dL) or at least a 50% increase in SCr from baseline and further classified into AKI Network stages. Duration of AKI was defined by the number of days AKI was present and categorized as no AKI and AKI for 1 to 2, 3 to 6, and at least 7 days.
Thirty-nine percent of patients exhibited AKI. Long-term survival was significantly different by AKI duration (p < 0.001). The proportion of patients with AKI duration, adjusted hazard ratio, and 95% confidence interval for mortality (no AKI as referent) were as follows: 1 to 2 days (18%; adjusted hazard ratio, 1.66; 95% confidence interval, 1.32 to 2.09), 3 to 6 days (11%; adjusted hazard ratio, 1.94; 95% confidence interval, 1.51 to 2.49), ≥7 days (9%; adjusted hazard ratio, 3.40; 95% confidence interval, 2.73 to 4.25). This graded relationship of duration of AKI with long-term mortality persisted when patients who died during hospitalization were excluded from analysis (p < 0.001). Propensity-matched analysis confirmed results.
The duration of AKI after cardiac surgery is directly proportional to long-term mortality. This AKI dose-dependent effect on long-term mortality helps to close the gap between association and causation, whereby AKI stages and AKI duration have important implications for patient care and can aid clinicians in evaluating the risk of in-hospital and postdischarge death.
心脏手术后发生急性肾损伤（AKI）与预后较差有关。然而，目前尚不清楚 AKI 的持续时间如何影响长期不良后果。我们旨在确定 AKI 持续时间与生存之间的关系。
回顾了 2002 年至 2007 年期间在新英格兰北部一家医疗中心接受心脏手术的 4987 名患者的病历，并检测了血清肌酐（SCr）。急性肾损伤的定义为 SCr 至少增加 0.3（mg/dL）或增加至少 50%，并进一步分为 AKI 网络分期。AKI 的持续时间定义为 AKI 存在的天数，并分为无 AKI 和 AKI 持续 1-2 天、3-6 天和至少 7 天。
39%的患者发生 AKI。AKI 持续时间的长期生存率有显著差异（p < 0.001）。AKI 持续时间的患者比例、调整后的危险比（HR）和 95%置信区间（CI）的死亡率（以无 AKI 为参照）如下：1-2 天（18%；调整后的 HR，1.66；95%CI，1.32-2.09），3-6 天（11%；调整后的 HR，1.94；95%CI，1.51-2.49），≥7 天（9%；调整后的 HR，3.40；95%CI，2.73-4.25）。当排除住院期间死亡的患者进行分析时，这种 AKI 持续时间与长期死亡率之间的分级关系仍然存在（p < 0.001）。倾向匹配分析证实了这一结果。
心脏手术后 AKI 的持续时间与长期死亡率直接相关。AKI 对长期死亡率的剂量依赖性影响有助于缩小关联和因果关系之间的差距，即 AKI 分期和 AKI 持续时间对患者的护理具有重要意义，并有助于临床医生评估住院期间和出院后的死亡风险。
