Interventional Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
Am Heart J. 2012 Jun;163(6):1031-6. doi: 10.1016/j.ahj.2012.01.009.
Patients undergoing transcatheter aortic valve replacement (TAVR) are at increased risk for acute kidney injury (AKI). The Valve Academic Research Consortium (VARC) recently published criteria for AKI after TAVR. We aimed to identify predictors, assess the prognostic impact of AKI after TAVR, and compare various criteria for AKI.
Patients with aortic stenosis undergoing TAVR were retrospectively analyzed for periprocedural AKI (<72 hours) according to the VARC definition (increase in serum creatinine ≥0.3 mg/dL or ≥1.5× baseline) or according to the modified Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria (decrease of >25% in estimated glomerular filtration rate at 48 hours).
Acute kidney injury, according to the VARC definition, occurred in 24 (14.6%) of 165 patients after TAVR. Acute kidney injury, according to RIFLE criteria, occurred in 19 patients (11.5%). Men (63% vs 38%, P = .03) and patients receiving blood transfusion (63% vs 39%, P = .04) were more likely to develop AKI. In multivariable analysis, only blood transfusion emerged as a predictor for AKI (odds ratio 3.74, 95% CI 1.36-10.3). Patients who developed AKI had higher in-hospital (21% vs 4%, P = .007) and 30-day mortality (29% vs 7%, P = .004) as compared with patients without AKI.
Acute kidney injury is a frequent complication of TAVR. Even a small increase (0.3 mg/dL) in baseline creatinine post-TAVR is associated with worse outcome. The poor prognosis of these patients should encourage improvement in patient selection and careful management for prevention of this complication.
接受经导管主动脉瓣置换术（TAVR）的患者发生急性肾损伤（AKI）的风险增加。阀学术研究联盟（VARC）最近发布了 TAVR 后 AKI 的标准。我们旨在确定预测因素，评估 TAVR 后 AKI 的预后影响，并比较 AKI 的各种标准。
根据 VARC 定义（血清肌酐升高≥0.3mg/dL 或≥1.5×基线）或根据改良的风险、损伤、衰竭、丧失和终末期肾病（RIFLE）标准（48 小时内估计肾小球滤过率下降>25%），对接受 TAVR 的主动脉瓣狭窄患者进行回顾性分析围手术期 AKI（<72 小时）。
根据 VARC 定义，24 例（165 例患者的 14.6%）患者在 TAVR 后发生 AKI。根据 RIFLE 标准，19 例患者（11.5%）发生 AKI。男性（63%比 38%，P=0.03）和接受输血的患者（63%比 39%，P=0.04）更可能发生 AKI。多变量分析显示，只有输血是 AKI 的预测因素（优势比 3.74，95%置信区间 1.36-10.3）。与无 AKI 的患者相比，发生 AKI 的患者院内（21%比 4%，P=0.007）和 30 天死亡率（29%比 7%，P=0.004）更高。
急性肾损伤是 TAVR 的常见并发症。TAVR 后基线肌酐升高（0.3mg/dL）与预后不良相关。这些患者的不良预后应鼓励改善患者选择和谨慎管理，以预防这种并发症。
