Kallel Sami, Triki Zied, Abdenadher Mohammed, Frikha Imed, Jemel Amine, Karoui Abdelhamid
Service d'anesthésie réanimation, CHU Habib-Bourguiba, 3000 Sfax, Tunisie.
Nephrol Ther. 2013 Apr;9(2):108-14. doi: 10.1016/j.nephro.2012.06.006. Epub 2012 Aug 21.
Acute renal failure is a common complication is a common complication in cardiac surgery under cardiopulmonary bypass. It is associated with increased morbidity and mortality. Acute kidney injury (AKI) is a clinical entity encompassing the entire spectrum of acute renal failure, since minor alterations to the need for renal replacement therapy. The RIFLE criteria have been proposed for defining and classifying AKI. The aim of our study was to apply the RIFLE to a population of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) and to assess its relevance in terms of risk factor for hospital mortality compared to other risk factors.
In this prospective observational study, we included patients who were operated for programmed cardiac surgery. The assay of blood creatinine was performed at admission, after surgery and daily for 5 days post-surgery. The AKI was evaluated according to the criteria of classification RIFLE. The patients were divided into three levels of severity based on plasmatic creatinine (R: Risk=creatinine×1.5; I: Injury=creatinine×2; F: Failure=creatinine×3). We have analyzed the different perioperative parameters and we sought associations with the occurrence of AKI. We also studied the impact of AKI on length of stay in ICU and mortality early and late.
One hundred and thirty-six patients were included. AKI was diagnosed in 17.6% of patients (RIFLE-R: 8.8%, RIFLE-I: 5.9% and RIFLE-F: 2.9%). AKI significantly prolongs the duration of ICU stay (7±3.8 versus 5±2.3 days; P=0.02). RIFLE-R patients had a mortality of 8.3%, compared to 12.5% for I and 50% for F. Patients without PORD had a mortality of 1.8%. In univariate analysis, age, the EURO score, preoperative renal dysfunction, duration of aortic clamping, duration of CPB and C-reactive protein (CRP) were significantly associated with the occurrence of AKI. In multivariate analysis only preoperative renal dysfunction (clearance less than 63 mL/min) and CRP greater than 158 mg/L were found as independent factors of occurrence of AKI.
RIFLE classification seems to be a reliable way to detect acute renal failure and to classify its severity. The AKI is a common complication and is associated with increased morbidity and mortality. Identifying the risk factors allows a better prevention strategy.
急性肾衰竭是体外循环心脏手术中常见的并发症。它与发病率和死亡率的增加相关。急性肾损伤（AKI）是一个临床实体，涵盖了急性肾衰竭的整个范围，从对肾脏替代治疗需求的微小改变到严重程度不等。RIFLE标准已被提出用于定义和分类AKI。我们研究的目的是将RIFLE标准应用于接受体外循环（CPB）心脏手术的患者群体，并与其他危险因素相比，评估其在医院死亡率危险因素方面的相关性。
在这项前瞻性观察研究中，我们纳入了接受计划性心脏手术的患者。在入院时、手术后以及术后5天每天进行血肌酐检测。根据RIFLE分类标准评估AKI。根据血肌酐水平将患者分为三个严重程度级别（R：风险=肌酐×1.5；I：损伤=肌酐×2；F：衰竭=肌酐×3）。我们分析了不同的围手术期参数，并寻找与AKI发生的关联。我们还研究了AKI对ICU住院时间以及早期和晚期死亡率的影响。
共纳入136例患者。17.6%的患者被诊断为AKI（RIFLE - R：8.8%，RIFLE - I：5.9%，RIFLE - F：2.9%）。AKI显著延长了ICU住院时间（7±3.8天对5±2.3天；P = 0.02）。RIFLE - R级患者的死亡率为8.3%，I级为12.5%，F级为50%。无术前肾功能不全风险因素（PORD）的患者死亡率为1.8%。在单因素分析中，年龄、欧洲心脏手术风险评估系统（EURO）评分、术前肾功能不全、主动脉阻断时间、CPB时间和C反应蛋白（CRP）与AKI的发生显著相关。在多因素分析中，仅术前肾功能不全（肌酐清除率低于63 mL/min）和CRP大于158 mg/L被发现是AKI发生的独立因素。
RIFLE分类似乎是检测急性肾衰竭及其严重程度分级的可靠方法。AKI是一种常见并发症，与发病率和死亡率增加相关。识别危险因素有助于制定更好的预防策略。
