Fernando Mangalee, Paterson Hugh S, Byth Karen, Robinson Benjamin M, Wolfenden Hugh, Gracey David, Harris David
Department of Nephrology, Prince of Wales Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia.
University of Sydney, Sydney, Australia.
J Thorac Cardiovasc Surg. 2014 Nov;148(5):2167-73. doi: 10.1016/j.jtcvs.2013.12.064. Epub 2014 Jan 15.
To identify predictors of early and late outcomes of cardiac surgery in patients with chronic kidney disease.
Patients (n=545) with serum creatinine≥200 μmol/L or renal dialysis were identified from databases maintained by the largest Sydney cardiothoracic surgical units with data consistent with the Australian and New Zealand Society of Cardiothoracic Surgeons data definitions. The patient data were matched against the National Dialysis Database and the New South Wales Register of Births, Deaths, and Marriages. Statistical analysis was used to identify predictors of early and late outcomes.
The Kaplan-Meier estimate of 1-, 5-, and 10-year survival for all patients was 78%, 56%, and 36%, respectively. The outcomes were similar after coronary bypass surgery and valve replacement and were also similar for dialysis and nondialysis patients. The odds ratios for the significant independent predictors of outcomes were, for perioperative death, age (1.4 per decade), emergency surgery (7.0), redo surgery (3.8), left ventricular impairment (moderate, 2.7; severe, 4.4); for new early postoperative dialysis, estimated glomerular filtration rate<20 mL/min (3.8), emergency surgery (2.7), tricuspid valve surgery (4.4); for new permanent dialysis within 6 months of surgery, serum estimated glomerular filtration rate<20 mL/min (odds ratio, 4.6). The hazard ratio for the independent predictors of late death in those alive 6 months after surgery was 1.4 per decade for age and 1.4 for moderate or severe left ventricular impairment.
Left ventricular impairment is a risk factor for perioperative and late death in patients with kidney disease. After cardiac surgery, preoperative dialysis-dependent and dialysis-free patients had similar long-term outcomes.
确定慢性肾病患者心脏手术早期和晚期预后的预测因素。
从悉尼最大的心胸外科手术单位维护的数据库中识别出血清肌酐≥200μmol/L或接受肾透析的患者（n = 545），其数据符合澳大利亚和新西兰心胸外科医师协会的数据定义。将患者数据与国家透析数据库以及新南威尔士州出生、死亡和婚姻登记册进行匹配。采用统计分析来确定早期和晚期预后的预测因素。
所有患者1年、5年和10年生存率的Kaplan-Meier估计值分别为78%、56%和36%。冠状动脉搭桥手术和瓣膜置换术后的预后相似，透析患者和非透析患者的预后也相似。预后的显著独立预测因素的比值比为，围手术期死亡方面，年龄（每十岁1.4）、急诊手术（7.0）、再次手术（3.8）、左心室功能不全（中度，2.7；重度，4.4）；术后新出现早期透析方面，估计肾小球滤过率<20 mL/min（3.8）、急诊手术（2.7）、三尖瓣手术（4.4）；术后6个月内新出现永久性透析方面，血清估计肾小球滤过率<20 mL/min（比值比，4.6）。术后存活6个月的患者晚期死亡的独立预测因素的风险比为年龄每十岁1.4，中度或重度左心室功能不全为1.4。
左心室功能不全是肾病患者围手术期和晚期死亡的危险因素。心脏手术后，术前依赖透析和不依赖透析的患者长期预后相似。
