Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Brendstrupgaardsvej, 8200 Aarhus N, Denmark.
Eur J Cardiothorac Surg. 2011 Jun;39(6):932-8. doi: 10.1016/j.ejcts.2010.09.043. Epub 2010 Nov 19.
To examine if preoperative microalbuminuria is associated with an increased risk of long-term adverse outcomes following elective cardiac surgery and if it provides additional prognostic information beyond the European System for Cardiac Operative Risk Evaluation (EuroSCORE).
In a prospective follow-up study, we included 1049 patients undergoing elective cardiac surgery from 1 April 2005 to 30 September 2007. Microalbuminuria (urine albumin/creatinine ratio between 2.5 and 25 mg mmol(-1)) was assessed preoperatively in a morning spot-urine sample. We used population-based medical registries for follow-up from day 31 until day 365 postoperatively, and compared all-cause death, myocardial infarction, cerebral stroke and a composite outcome of severe infections including septicaemia, deep or superficial sternal wound infection, or leg wound infection among patients with or without microalbuminuria using Cox proportional hazard and competing risk regressions.
Microalbuminuria was found in 175 (18.5%) out of 947 patients available for follow-up. The adjusted risks of all-cause death (adjusted hazard ratio 2.3 (95% confidence interval 1.1-4.9)), stroke (adjusted hazard ratio 2.9 (95% confidence interval 1.1-7.8)) and severe infection composite outcome (adjusted hazard ratio 2.4 (95% confidence interval 1.2-4.9)) were doubled to tripled in patients with preoperative microalbuminuria. The risk of myocardial infarction was not increased. Adding information on microalbuminuria improved the predictive accuracy of the EuroSCORE regarding mortality (areas under receiver operating characteristic curves were: for the EuroSCORE 0.73 (95% confidence interval 0.65-0.81) and for EuroSCORE+microalbuminuria 0.76 (95% confidence interval 0.68-0.83).
Preoperative microalbuminuria is associated with an increased risk of long-term adverse outcomes in patients undergoing elective cardiac surgery, and it appears to provide prognostic information on mortality.
研究择期心脏手术后术前微量白蛋白尿是否与长期不良预后相关，以及微量白蛋白尿是否在欧洲心脏手术风险评估系统（EuroSCORE）之外提供额外的预后信息。
在一项前瞻性随访研究中，我们纳入了 2005 年 4 月 1 日至 2007 年 9 月 30 日期间接受择期心脏手术的 1049 例患者。术前在清晨的单次尿样中评估微量白蛋白尿（尿白蛋白/肌酐比值为 2.5 至 25mgmmol(-1))。我们使用基于人群的医疗登记系统，对术后第 31 天至第 365 天进行随访，比较微量白蛋白尿患者和无微量白蛋白尿患者的全因死亡、心肌梗死、脑卒中和严重感染（包括败血症、深部或浅部胸骨伤口感染或腿部伤口感染）的复合结局，使用 Cox 比例风险和竞争风险回归进行分析。
在 947 例可进行随访的患者中，有 175 例（18.5%）发现微量白蛋白尿。在调整了其他因素后，微量白蛋白尿患者的全因死亡风险（调整后的危险比 2.3（95%置信区间 1.1-4.9））、卒中和严重感染复合结局风险（调整后的危险比 2.4（95%置信区间 1.2-4.9））分别增加了一倍至三倍。而心肌梗死的风险没有增加。在 EuroSCORE 中加入微量白蛋白尿信息可以提高死亡率的预测准确性（受试者工作特征曲线下面积：EuroSCORE 为 0.73（95%置信区间 0.65-0.81），EuroSCORE+微量白蛋白尿为 0.76（95%置信区间 0.68-0.83）。
择期心脏手术后术前微量白蛋白尿与长期不良预后相关，且似乎提供了死亡率的预后信息。
