University Medical Center Regensburg, Department of Cardiothoracic Surgery, Franz-Josef-Strauss-Allee 11, Regensburg, Germany.
BMC Cardiovasc Disord. 2011 Aug 11;11:52. doi: 10.1186/1471-2261-11-52.
An increasing number of septua- and octogenarians undergo cardiac surgery. Acute kidney injury (AKI) still is a frequent complication after surgery. We examined the incidence of AKI and its impact on 30-day mortality.
A retrospective study between 01/2006 and 08/2009 with 299 octogenarians, who were matched for gender and surgical procedure to 299 septuagenarians at a university hospital. Primary endpoint was AKI after surgery as proposed by the RIFLE definition (Risk, Injury, Failure, Loss, End-stage kidney disease). Secondary endpoint was 30-day mortality. Perioperative mortality was predicted with the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE).
Octogenarians significantly had a mean higher logistic EuroSCORE compared to septuagenarians (13.2% versus 8.5%; p < 0.001) and a higher proportion of patients with an estimated glomerular filtration rate (eGFR) < 60 ml × min-1 × 1.73 m-2. In contrast, septuagenarians showed a slightly higher median body mass index (28 kg × m-2 versus 26 kg × m-2) and were more frequently active smoker at time of surgery (6.4% versus 1.6%, p < 0.001). Acute kidney injury and failure developed in 21.7% of septuagenarians and in 21.4% of octogenarians, whereas more than 30% of patients were at risk for AKI (30% and 36.3%, respectively). Greater degrees of AKI were associated with a stepwise increase in risk for death, renal replacement therapy and prolonged stays at the intensive care unit and at the hospital in both age groups, but without differences between them. Overall 30-day mortality was 6% in septuagenarians and 7.7% in octogenarians (p = 0.52).The RIFLE classification provided accurate risk assessment for 30-day mortality and fair discriminatory power.
The RIFLE criteria allow identifying patients with AKI after cardiac surgery. The high incidence of AKI in septua- and octogenarians after cardiac surgery should prompt the use of RIFLE criteria to identify patients at risk and should stimulate institutional measures that target AKI as a quality improvement initiative for patients at advanced age.
越来越多的八九十岁老人接受心脏手术。急性肾损伤（AKI）仍然是手术后的常见并发症。我们检查了 AKI 的发生率及其对 30 天死亡率的影响。
这是一项回顾性研究，比较了 2006 年 1 月至 2009 年 8 月在一所大学医院接受手术的 299 名 80 岁以上老人和 299 名 70 岁以下老人。主要终点是 RIFLE 定义（风险、损伤、衰竭、损失、终末期肾病）提出的手术后 AKI。次要终点是 30 天死亡率。手术期间用逻辑欧洲心脏手术风险评估系统（EuroSCORE）预测围手术期死亡率。
与 70 岁以下的患者相比，80 岁以上的患者平均逻辑 EuroSCORE 明显更高（13.2%比 8.5%；p<0.001），估计肾小球滤过率（eGFR）<60ml×min-1×1.73m-2的患者比例也更高。相比之下，70 岁以下的患者中位体重指数（28kg×m-2）稍高，手术时更常为主动吸烟者（6.4%比 1.6%，p<0.001）。70 岁以下的患者和 80 岁以上的患者急性肾损伤和衰竭的发生率分别为 21.7%和 21.4%，但超过 30%的患者有 AKI 风险（分别为 30%和 36.3%）。在两个年龄组中，AKI 程度越严重，死亡、肾脏替代治疗和在重症监护病房和医院的住院时间延长的风险呈逐步增加，但两组之间没有差异。70 岁以下的患者 30 天死亡率为 6%，80 岁以上的患者为 7.7%（p=0.52）。RIFLE 分类对 30 天死亡率有准确的风险评估和适度的判别能力。
RIFLE 标准可用于识别心脏手术后 AKI 患者。心脏手术后八九十岁老人 AKI 的高发生率应促使使用 RIFLE 标准来识别高危患者，并应鼓励采取机构措施，将 AKI 作为提高高龄患者质量的一项举措。
