心脏手术后急性肾损伤持续时间的决定因素：一种经外部验证的工具。
Determinants of acute kidney injury duration after cardiac surgery: an externally validated tool.
机构信息
The Dartmouth Institute for Health Policy and Clinical Practice, Section of Cardiology Dartmouth-Hitchcock Medical Center, and Dartmouth Medical School, Lebanon, New Hampshire 03756, USA.
出版信息
Ann Thorac Surg. 2012 Feb;93(2):570-6. doi: 10.1016/j.athoracsur.2011.11.004. Epub 2011 Dec 28.
BACKGROUND
Acute kidney injury (AKI) duration after cardiac surgery is associated with poor survival in a dose-dependent manner. However, it is not known what perioperative risk factors contribute to prolonged AKI and delayed recovery. We sought to identify perioperative risk factors that predict duration of AKI, a complication that effects short and long-term survival.
METHODS
We studied 4,987 consecutive cardiac surgery patients from 2002 through 2007. Acute kidney injury was defined as a 0.3 or greater (mg/dL) or 50% or greater increase in serum creatinine from baseline. Duration of AKI was defined by the number of days AKI was present. Stepwise multivariable negative binomial regression analysis was conducted using perioperative risk factors for AKI duration. The c-index was estimated by Kendall's tau.
RESULTS
Acute kidney injury developed in 39% of patients with a median duration of AKI at 3 days and ranged from 1 to 108 days. Patients without AKI had a duration of 0 days. Independent predictors of AKI duration included baseline patient and disease characteristics, and operative and postoperative factors. Prediction for mean duration of AKI was developed using coefficients from the regression model and externally validated the model on 1,219 cardiac surgery patients in a separate cardiac surgery cohort (Translational Research Investigating Biomarker Endpoints-AKI). The c-index was 0.65 (p<0.001) for the derivation cohort and 0.62 (p<0.001) for the validation cohort.
CONCLUSIONS
We identified and externally validated perioperative predictors of AKI duration. These risk factors will be useful to evaluate a patient's risk for the tempo of recovery from AKI after cardiac surgery and subsequent short and long-term survival. The levels of awareness created by working with these risk factors have implications regarding positive changes in processes of care that have the potential to decrease the incidence and mitigate AKI.
背景
心脏手术后急性肾损伤（AKI）的持续时间与剂量依赖性的不良预后相关。然而，目前尚不清楚哪些围手术期危险因素会导致 AKI 延长和恢复延迟。我们旨在确定预测 AKI 持续时间的围手术期危险因素，AKI 是一种影响短期和长期生存的并发症。
方法
我们研究了 2002 年至 2007 年期间连续 4987 例心脏手术患者。急性肾损伤的定义为血清肌酐较基线水平升高 0.3mg/dL 或 50%以上。AKI 的持续时间定义为 AKI 存在的天数。采用逐步多变量负二项回归分析 AKI 持续时间的围手术期危险因素。采用 Kendall's tau 估计 c 指数。
结果
39%的患者发生 AKI，AKI 的中位持续时间为 3 天，范围为 1 至 108 天。无 AKI 的患者 AKI 持续时间为 0 天。AKI 持续时间的独立预测因素包括基线患者和疾病特征以及手术和术后因素。使用回归模型中的系数为 AKI 持续时间开发预测模型，并在另一个心脏手术队列（转化研究调查生物标志物终点 - AKI）的 1219 例心脏手术患者中对模型进行外部验证。推导队列的 c 指数为 0.65（p<0.001），验证队列的 c 指数为 0.62（p<0.001）。
结论
我们确定并外部验证了 AKI 持续时间的围手术期预测因素。这些危险因素将有助于评估患者心脏手术后 AKI 恢复速度以及随后的短期和长期生存风险。通过使用这些危险因素进行工作所产生的认识水平对护理流程的积极改变具有影响，这有可能降低 AKI 的发生率并减轻其影响。
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